Provider Demographics
NPI:1609804400
Name:ZITO, GREGORY (MD,)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:ZITO
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 1:306 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1201
Mailing Address - Country:US
Mailing Address - Phone:516-678-1559
Mailing Address - Fax:516-764-5738
Practice Address - Street 1:306 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1201
Practice Address - Country:US
Practice Address - Phone:516-678-1559
Practice Address - Fax:516-764-5738
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161504174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01084257Medicaid
NY27E461OtherBLUE CROSS AND BLUE SHEILD OF NEW YORK
NY27E461OtherBLUE CROSS AND BLUE SHEILD OF NEW YORK
NY27E461Medicare PIN