Provider Demographics
NPI:1902809981
Name:ZUCKERBERG, EDWARD JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAY
Last Name:ZUCKERBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RUSSELL PL
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1509
Mailing Address - Country:US
Mailing Address - Phone:914-693-9696
Mailing Address - Fax:914-693-6714
Practice Address - Street 1:2 RUSSELL PL
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1509
Practice Address - Country:US
Practice Address - Phone:914-693-9696
Practice Address - Fax:914-693-6714
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0337111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice