Provider Demographics
NPI:1336722024
Name:ZUCKER, JORDAN COLE (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:COLE
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OLD COUNTRY ROAD
Mailing Address - Street 2:STE 370
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-2171
Mailing Address - Fax:516-663-2179
Practice Address - Street 1:200 OLD COUNTRY ROAD
Practice Address - Street 2:STE 370
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-2171
Practice Address - Fax:516-663-2179
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine