Provider Demographics
NPI:1114918398
Name:ZISFEIN, JEROME B (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:B
Last Name:ZISFEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MERRICK RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5254
Mailing Address - Country:US
Mailing Address - Phone:516-763-2800
Mailing Address - Fax:
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:SUITE 402
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-763-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178108207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01280446Medicaid
NY01280446Medicaid
NYE04001Medicare UPIN