Provider Demographics
NPI:1699953729
Name:JOEL ZUCKERBRAUN ODPL
Entity type:Organization
Organization Name:JOEL ZUCKERBRAUN ODPL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKERBRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-376-2848
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:8 NORTH MAIN STREET
Mailing Address - City:JEWETT CITY
Mailing Address - State:CT
Mailing Address - Zip Code:06351
Mailing Address - Country:US
Mailing Address - Phone:860-376-2848
Mailing Address - Fax:860-376-4821
Practice Address - Street 1:8 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:JEWETT CITY
Practice Address - State:CT
Practice Address - Zip Code:06351
Practice Address - Country:US
Practice Address - Phone:860-376-2848
Practice Address - Fax:860-376-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1014152W00000X
CT561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004194461Medicaid