Active NPI
Gary Bruce Zuckerman, M.D.
- Allergy Physician
- Kendall Park, NJ
National Provider Identifier
1174672463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy Physician
- License
- 177662-1
- Practice address
- 3084 Highway 27
Suite 6
Kendall Park, NJ 08824 - Phone
- (732) 821-0595
- Fax
- (732) 821-1174
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | MA60083 | NJ | |
| Allergy Physician | 207KA0200X | 177662-1 | NJ | Primary |
Addresses
Primary practice location
3084 Highway 27
Suite 6
Kendall Park, NJ 08824
Mailing address
32 Randall Rd
Princeton, NJ 08540-3610
Phone (609) 430-1207
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02337171 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 177662-1 | NJ | MD | Allergy Physician |
| MA60083 | NJ | MD | Allergy Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174672463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 RANDALL RD",
"city": "PRINCETON",
"state": "NJ",
"postal_code": "085403610",
"telephone_number": "609-430-1207"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3084 HIGHWAY 27",
"address_2": "SUITE 6",
"city": "KENDALL PARK",
"state": "NJ",
"postal_code": "08824",
"telephone_number": "732-821-0595",
"fax_number": "732-821-1174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUCKERMAN",
"first_name": "GARY",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207KA0200X",
"taxonomy_group": "",
"desc": "Allergy & Immunology, Allergy",
"state": "NJ",
"license": "MA60083",
"primary": false
},
{
"code": "207KA0200X",
"taxonomy_group": "",
"desc": "Allergy & Immunology, Allergy",
"state": "NJ",
"license": "177662-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02337171",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kendall Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.