Provider Demographics
NPI:1245358167
Name:ZISK, JODY L (DO)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:L
Last Name:ZISK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LYNN
Other - Last Name:KOHUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-8735
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6695
Practice Address - Fax:215-456-6769
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0003010208000000X
PA0T011001208000000X
PAOS015019208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics