Healthcare Provider Details

I. General information

NPI: 1356338453
Provider Name (Legal Business Name): JOHN J ZISA D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 E 67TH ST SUITE 4R
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: 212-288-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003458
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD01529
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: