Provider Demographics
NPI:1720253578
Name:DAVID ZUCKER MD LLC
Entity Type:Organization
Organization Name:DAVID ZUCKER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-873-0333
Mailing Address - Street 1:999 ORONOQUE LANE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1379
Mailing Address - Country:US
Mailing Address - Phone:203-873-0333
Mailing Address - Fax:203-873-0336
Practice Address - Street 1:999 ORONOQUE LN
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1379
Practice Address - Country:US
Practice Address - Phone:203-873-0333
Practice Address - Fax:203-873-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0277572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100000095OtherMEDICARE PTAN
B38667Medicare UPIN