Provider Demographics
NPI:1285809277
Name:ZUZZOLO, KRISTINA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:ZUZZOLO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2625
Mailing Address - Country:US
Mailing Address - Phone:631-744-6666
Mailing Address - Fax:631-744-0525
Practice Address - Street 1:555 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2625
Practice Address - Country:US
Practice Address - Phone:631-744-6666
Practice Address - Fax:631-744-0525
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical