Provider Demographics
NPI:1336254457
Name:ZISK, GARY (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:ZISK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 BAY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2634
Mailing Address - Country:US
Mailing Address - Phone:718-259-1979
Mailing Address - Fax:718-259-8158
Practice Address - Street 1:8223 BAY PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2634
Practice Address - Country:US
Practice Address - Phone:718-259-1979
Practice Address - Fax:718-259-8158
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine