Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 023425-1 | NY |
NPI | 1093934622 |
---|---|
Provider Name | Dr. Gabriel Robert Zuckerman |
First Address | East Northport, NY 11731-2634 |
Second Address | East Northport, NY 11731-2634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |