Provider Demographics
NPI:1023002060
Name:ZISBROD, ZVI (MD)
Entity type:Individual
Prefix:
First Name:ZVI
Middle Name:
Last Name:ZISBROD
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 1:474 OVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1550
Mailing Address - Country:US
Mailing Address - Phone:718-946-4500
Mailing Address - Fax:718-946-2120
Practice Address - Street 1:474 OVINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1550
Practice Address - Country:US
Practice Address - Phone:718-946-4500
Practice Address - Fax:718-946-2120
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141838208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00812771Medicaid
NY00812771Medicaid
NY120201Medicare ID - Type Unspecified