Provider Demographics
NPI:1356338453
Name:ZISA, JOHN J (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:ZISA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6119
Mailing Address - Country:US
Mailing Address - Phone:212-288-0080
Mailing Address - Fax:212-288-3721
Practice Address - Street 1:34 E 67TH ST
Practice Address - Street 2:SUITE 4R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6119
Practice Address - Country:US
Practice Address - Phone:212-288-0080
Practice Address - Fax:212-288-3721
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003458213E00000X
NJMD01529213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP481831OtherOXFORD
NJ12162OtherAMERIGROUP
NY0088694OtherGHI
NJ0388238000OtherAMERIHEALTH
NYF15937OtherHEALTHNET
NJF15937OtherHEALTHNET
NJ16474OtherUNIVERSITY HEALTH PLANS
NJBS688OtherOXFORD
NJ12162OtherAMERIGROUP
NJF15937OtherHEALTHNET
NYF15937OtherHEALTHNET
NY0088694OtherGHI
NY4059970002Medicare NSC