Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 177662-1 | NJ |
N | 207KA0200X | Allergist | MA60083 | NJ |
NPI | 1174672463 |
---|---|
Provider Name | Dr. Gary Bruce Zuckerman |
First Address | Princeton, NJ 08540-3610 |
Second Address | Kendall Park, NJ 08824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02337171 | (05) | NJ |
F74388 | (02) | NJ |