Provider Demographics
NPI:1437189420
Name:ZIFFERBLATT, JOCKO R (DO)
Entity Type:Individual
Prefix:
First Name:JOCKO
Middle Name:R
Last Name:ZIFFERBLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1405 MILL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-2155
Practice Address - Country:US
Practice Address - Phone:920-531-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41087-021207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30093400Medicaid
MI114160684Medicaid
WI930077089OtherMEDICARE RAILROAD
WI930077090OtherMEDICARE RAILROAD
WI930079991OtherMEDICARE RAILROAD
WI0067-68655Medicare ID - Type Unspecified
WI0011-40115Medicare ID - Type Unspecified
MI114160684Medicaid
WI30093400Medicaid