Provider Demographics
NPI:1164550141
Name:JOHN J ZISA
Entity Type:Organization
Organization Name:JOHN J ZISA
Other - Org Name:CONSERVATIVE FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZISA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-288-0080
Mailing Address - Street 1:34 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6119
Mailing Address - Country:US
Mailing Address - Phone:212-288-0080
Mailing Address - Fax:
Practice Address - Street 1:34 E 67TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6119
Practice Address - Country:US
Practice Address - Phone:212-288-0080
Practice Address - Fax:212-288-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003458213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP481831OtherOXFORD
NY0088694OtherGHI
NJBS668OtherOXFORD
NJF15937OtherHEALTHNET
NYP481831OtherOXFORD
NYT51103Medicare UPIN
NYP36651Medicare PIN
NJBS668OtherOXFORD