Healthcare Provider Details

I. General information

NPI: 1629134838
Provider Name (Legal Business Name): ZIZCO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 3RD AVE
NEW YORK NY
10016-4168
US

IV. Provider business mailing address

541 3RD AVE
NEW YORK NY
10016-4168
US

V. Phone/Fax

Practice location:
  • Phone: 212-684-0202
  • Fax: 212-684-7544
Mailing address:
  • Phone: 212-684-0202
  • Fax: 212-684-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number7200
License Number StateNY

VIII. Authorized Official

Name: MR. SCOTT DAVID COHEN
Title or Position: OPTICIAN
Credential: LOD
Phone: 212-684-0202