Provider Demographics
NPI:1740215268
Name:ZITSMAN, JEFFREY LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEONARD
Last Name:ZITSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-342-8585
Mailing Address - Fax:914-722-6739
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:CHN 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-342-8585
Practice Address - Fax:914-722-6739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1544492086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01082475Medicaid