Healthcare Provider Details

I. General information

NPI: 1295053718
Provider Name (Legal Business Name): JENNIFER ZISKIN M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MARSHALL ST BLDG 4TH
REDWOOD CITY CA
94063-2026
US

IV. Provider business mailing address

901 MARSHALL ST MARSHALL BUILDING 4TH
REDWOOD CITY CA
94063-2026
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-3218
  • Fax: 650-299-2301
Mailing address:
  • Phone: 650-299-3218
  • Fax: 650-299-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberA117752
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA117752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: