Healthcare Provider Details

I. General information

NPI: 1548340672
Provider Name (Legal Business Name): JOYCE R ZISSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCCOSH HEALTH CTR WASHINGTON RD.
PRINCETON NJ
08544-0001
US

IV. Provider business mailing address

16 ANGELICA CT
PRINCETON NJ
08540-9420
US

V. Phone/Fax

Practice location:
  • Phone: 609-258-6226
  • Fax: 609-258-1355
Mailing address:
  • Phone: 732-438-1049
  • Fax: 732-438-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberMA021153
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: