Provider Demographics
NPI:1568559649
Name:KIZER, JORGE R (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:R
Last Name:KIZER
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 1:1300 MORRIS PARK AVE
Mailing Address - Street 2:ALBERT EINSTEIN COLLEGE OF MEDICINE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1900
Mailing Address - Country:US
Mailing Address - Phone:718-839-7917
Mailing Address - Fax:718-430-8989
Practice Address - Street 1:1628 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2663
Practice Address - Country:US
Practice Address - Phone:646-670-5125
Practice Address - Fax:646-670-5121
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220618207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140449Medicaid
NY02140449Medicaid
NYH21267Medicare UPIN