Provider Demographics
NPI:1316719743
Name:ZUCCONI, JOSEPH JOHN (PTDPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:ZUCCONI
Suffix:
Gender:M
Credentials:PTDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SHADOWLAKE DR
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5524
Mailing Address - Country:US
Mailing Address - Phone:917-623-5697
Mailing Address - Fax:
Practice Address - Street 1:140 MEISNER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1236
Practice Address - Country:US
Practice Address - Phone:718-989-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027094-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist