Provider Demographics
NPI:1659384584
Name:ZISIS, ELEFTHERIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEFTHERIOS
Middle Name:
Last Name:ZISIS
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 1:55 HATHAWAY LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX FELLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07021-1304
Mailing Address - Country:US
Mailing Address - Phone:973-403-8262
Mailing Address - Fax:973-403-8262
Practice Address - Street 1:55 HATHAWAY LN
Practice Address - Street 2:
Practice Address - City:ESSEX FELLS
Practice Address - State:NJ
Practice Address - Zip Code:07021-1304
Practice Address - Country:US
Practice Address - Phone:973-403-8262
Practice Address - Fax:973-403-8262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA360532086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017008OtherGHI
NJES541OtherOXFORD
NY090D70100OtherBLUE CROSS
NJ466355OtherCIGNA
NY090D70100OtherBLUE CROSS
NJDO6453Medicare UPIN
NJ0777005Medicare ID - Type Unspecified