Provider Demographics
NPI:1295104222
Name:JAN ZISLIS, M.D., PLLC
Entity type:Organization
Organization Name:JAN ZISLIS, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZISLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-984-5052
Mailing Address - Street 1:3010 WESTCHESTER AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2524
Mailing Address - Country:US
Mailing Address - Phone:914-984-5052
Mailing Address - Fax:914-574-2348
Practice Address - Street 1:3010 WESTCHESTER AVE STE 105
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2524
Practice Address - Country:US
Practice Address - Phone:914-984-5052
Practice Address - Fax:914-574-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221479-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty