Healthcare Provider Details

I. General information

NPI: 1255056313
Provider Name (Legal Business Name): NIKKI J ZIZZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

61 HEMLOCK LN
MASSAPEQUA PARK NY
11762-3916
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-4118
  • Fax:
Mailing address:
  • Phone: 516-698-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number777044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: