Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 055511-1 | NY |
NPI | 1053699967 |
---|---|
Provider Name | Dr. Brett Michael Zuckman |
First Address | Scarsdale, NY 10583-3242 |
Second Address | New York, NY 10019-3158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2011 |
Last Update Date | 26/07/2011 |