Provider Demographics
NPI:1477668697
Name:ZISU, MANUELA PASCOLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUELA
Middle Name:PASCOLINA
Last Name:ZISU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NATHAN D PERLMAN PL
Mailing Address - Street 2:2 BERNSTEIN PAV.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3851
Mailing Address - Country:US
Mailing Address - Phone:212-420-2488
Mailing Address - Fax:
Practice Address - Street 1:10 NATHAN D PERLMAN PL
Practice Address - Street 2:2 BERNSTEIN PAV.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3851
Practice Address - Country:US
Practice Address - Phone:212-420-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215639-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02374656Medicaid
NY090BR1Medicare ID - Type UnspecifiedMEDICARE PROV NUMBER
NY02374656Medicaid