Provider Demographics
NPI:1588394027
Name:AZIZA, ZISA OYEAMA
Entity type:Individual
Prefix:
First Name:ZISA
Middle Name:OYEAMA
Last Name:AZIZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OYEAMA
Other - Middle Name:CAPRE
Other - Last Name:OKPALOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:518 W 159TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-6966
Mailing Address - Country:US
Mailing Address - Phone:347-256-4944
Mailing Address - Fax:
Practice Address - Street 1:2261 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6486
Practice Address - Country:US
Practice Address - Phone:347-256-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P2238175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNYCPS-P-2238Medicaid