Provider Demographics
NPI:1356572531
Name:ZIZMOR, NAVAH (DPT)
Entity type:Individual
Prefix:
First Name:NAVAH
Middle Name:
Last Name:ZIZMOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 POST RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1169
Mailing Address - Country:US
Mailing Address - Phone:203-307-4600
Mailing Address - Fax:203-307-4601
Practice Address - Street 1:83 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5506
Practice Address - Country:US
Practice Address - Phone:203-307-4600
Practice Address - Fax:203-307-4601
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031664-1225100000X
CT010341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist