Provider Demographics
NPI:1467414896
Name:NZUZI, SIMON MUAKA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:MUAKA
Last Name:NZUZI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:MRS
Other - First Name:BERNADETTE
Other - Middle Name:NTOYA
Other - Last Name:NZUZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:12118 LAURELTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1047
Mailing Address - Country:US
Mailing Address - Phone:212-410-8069
Mailing Address - Fax:212-410-8440
Practice Address - Street 1:20507 HILLSIDE AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2220
Practice Address - Country:US
Practice Address - Phone:718-479-7993
Practice Address - Fax:212-410-8440
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO3037213E00000X
NYN003037213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0046447OtherGHI PROVIDER NUMBER
NY#0276134OtherCIGNA-MEDICARE
NY115, 119, 65OtherFIDELIS
NYMPI:28980OtherUNITED HEALTH PLANS
NYSP13669OtherCENTER CARE PROVIDER NUMB
NY0047963Medicaid
NY396200POtherHIP PROVIDER NUMBER
NY0029644 P-64 P110OtherOXFORD PLANS
NYP34003SNOtherBLEU CROSS/BLEU SHIELD
NYP.3037-0OtherWORKER-COMPENSATION
NYMPI:28980OtherUNITED HEALTH PLANS
NY115, 119, 65OtherFIDELIS
NY0047963Medicaid