Healthcare Provider Details

I. General information

NPI: 1164550141
Provider Name (Legal Business Name): JOHN J ZISA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 E 67TH ST
NEW YORK NY
10065-6119
US

IV. Provider business mailing address

34 E 67TH ST
NEW YORK NY
10065-6119
US

V. Phone/Fax

Practice location:
  • Phone: 212-288-0080
  • Fax: 212-288-3721
Mailing address:
  • Phone: 212-288-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number003458
License Number StateNY

VIII. Authorized Official

Name: DR. JOHN JOSEPH ZISA
Title or Position: OWNER
Credential: D.P.M.
Phone: 212-288-0080