Provider Demographics
NPI:1578095717
Name:MIRZA, ZEYN T
Entity Type:Individual
Prefix:DR
First Name:ZEYN
Middle Name:T
Last Name:MIRZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 WEST MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5343
Mailing Address - Country:US
Mailing Address - Phone:220-564-2950
Mailing Address - Fax:220-564-2951
Practice Address - Street 1:1717 WEST MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5343
Practice Address - Country:US
Practice Address - Phone:220-564-2950
Practice Address - Fax:220-564-2951
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21732207R00000X
OH35.148279207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine