Provider Demographics
NPI:1114921616
Name:ZISBLATT, URI MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:URI
Middle Name:MARTIN
Last Name:ZISBLATT
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 1:210 W SAN BERNARDINO RD
Mailing Address - Street 2:DEPT OF RAD ONC
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1515
Mailing Address - Country:US
Mailing Address - Phone:626-915-6280
Mailing Address - Fax:626-859-5829
Practice Address - Street 1:210 W SAN BERNARDINO RD
Practice Address - Street 2:DEPT OF RAD ONC
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1515
Practice Address - Country:US
Practice Address - Phone:626-915-6280
Practice Address - Fax:626-859-5829
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG801952085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G801950Medicaid
CAP00796214OtherRAILROAD MEDICARE
920003242OtherRAILROAD MEDICARE
CA5568573OtherAETNA
CA4988508OtherCIGNA PROVIDER #
CA4988508OtherCIGNA PROVIDER #
CAP00796214OtherRAILROAD MEDICARE
CA5568573OtherAETNA