Provider Demographics
NPI:1366492134
Name:ZISLIS, JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:ZISLIS
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 1:15 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1723
Mailing Address - Country:US
Mailing Address - Phone:914-984-5052
Mailing Address - Fax:914-574-2348
Practice Address - Street 1:15 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1743
Practice Address - Country:US
Practice Address - Phone:914-984-5052
Practice Address - Fax:914-574-2348
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039097207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH48410Medicare UPIN
CT930001250Medicare ID - Type Unspecified