Provider Demographics
NPI:1790846244
Name:ZUCKERMAN, MARK JULIAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JULIAN
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:373 ROUTE 111
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4759
Mailing Address - Country:US
Mailing Address - Phone:631-360-3366
Mailing Address - Fax:631-360-3380
Practice Address - Street 1:373 ROUTE 111
Practice Address - Street 2:SUITE 20
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4759
Practice Address - Country:US
Practice Address - Phone:631-360-3366
Practice Address - Fax:631-360-3380
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1712222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20E061Medicare PIN
A61165Medicare UPIN