Provider Demographics
NPI:1831246354
Name:ZUCCALA, NICHOLAS (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ZUCCALA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BELLEMEADE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1871
Mailing Address - Country:US
Mailing Address - Phone:631-360-2965
Mailing Address - Fax:631-724-4281
Practice Address - Street 1:15 BELLEMEADE AVE STE 11
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1871
Practice Address - Country:US
Practice Address - Phone:631-360-2965
Practice Address - Fax:631-724-4281
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007251111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX58571Medicare PIN