Provider Demographics
NPI:1669547220
Name:ZUCKER, JOSEPH STEPHEN (PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 LEXINGTON AVE
Mailing Address - Street 2:APT 3W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2543
Mailing Address - Country:US
Mailing Address - Phone:212-628-1330
Mailing Address - Fax:212-722-8513
Practice Address - Street 1:1449 LEXINGTON AVE
Practice Address - Street 2:3W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2543
Practice Address - Country:US
Practice Address - Phone:212-628-1330
Practice Address - Fax:212-722-8513
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01714850Medicaid
NY01714850Medicaid