Provider Demographics
NPI:1194045922
Name:ZISO, YONATAN
Entity Type:Individual
Prefix:
First Name:YONATAN
Middle Name:
Last Name:ZISO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 E 23RD ST APT. 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2847
Mailing Address - Country:US
Mailing Address - Phone:718-757-4017
Mailing Address - Fax:
Practice Address - Street 1:2629 E 23RD ST APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2849
Practice Address - Country:US
Practice Address - Phone:718-757-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist