Provider Demographics
NPI:1659031177
Name:MASSAR, ZIA WALDMAN (AGACNP)
Entity Type:Individual
Prefix:
First Name:ZIA
Middle Name:WALDMAN
Last Name:MASSAR
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:ZIA
Other - Middle Name:GABRIELLE
Other - Last Name:WALDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:1107 1ST AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8708
Mailing Address - Country:US
Mailing Address - Phone:914-374-3153
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432120363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care