Healthcare Provider Details

I. General information

NPI: 1760694673
Provider Name (Legal Business Name): ISRAEL ZYSKIND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 AVENUE L
BROOKLYN NY
11210-5441
US

IV. Provider business mailing address

3411 AVENUE L
BROOKLYN NY
11210-5441
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-8090
  • Fax: 718-858-1002
Mailing address:
  • Phone: 718-998-8090
  • Fax: 718-858-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10597300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number238776
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: