Provider Demographics
NPI:1801881081
Name:ZUCKERBERG, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ZUCKERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:WACCABUC
Mailing Address - State:NY
Mailing Address - Zip Code:10597-1014
Mailing Address - Country:US
Mailing Address - Phone:914-763-9616
Mailing Address - Fax:
Practice Address - Street 1:GRASSLANDS RD
Practice Address - Street 2:WESTCHESTER MEDICAL CENTER
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7656
Practice Address - Fax:914-493-8261
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190698207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
061009000084OtherFIDELIS CARE OF NY
5C7520OtherHEALTHNET PIN #
P2830825OtherOXFORD HEALTH PIN#
4147748OtherMVP HEALTHPLAN PIN#
1526Q1OtherEMPIRE BC BS
000000109857OtherGHI HMO PIN #
10039781OtherCDPHP PIN #
01488564OtherGHI PPO PIN #
7152520OtherAETNA PPO PIN#
1082120OtherAETNA HMO PIN #
1526Q1OtherEMPIRE BC BS
061009000084OtherFIDELIS CARE OF NY
P2830825OtherOXFORD HEALTH PIN#