Healthcare Provider Details

I. General information

NPI: 1346203205
Provider Name (Legal Business Name): MICHELE J ZISKIND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE LANKENAU MED OFFICE BLDG EAST, SUITE 456
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE LANKENAU MED OFFICE BLDG EAST, SUITE 456
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-8541
  • Fax:
Mailing address:
  • Phone: 610-649-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD023774E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: