Healthcare Provider Details

I. General information

NPI: 1528085289
Provider Name (Legal Business Name): VINCENT JAMES ZIZZA III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD
WARWICK RI
02886-1617
US

IV. Provider business mailing address

176 TOLL GATE ROAD SUITE 301
WARWICK RI
02886-4411
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-2984
  • Fax: 401-739-0867
Mailing address:
  • Phone: 401-739-2984
  • Fax: 401-739-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDO487
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDO00487
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: