Provider Demographics
NPI:1588492961
Name:AZ PODIATRY PLLC
Entity type:Organization
Organization Name:AZ PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIZZAMIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-852-8882
Mailing Address - Street 1:PO BOX 7270
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-7270
Mailing Address - Country:US
Mailing Address - Phone:951-656-1500
Mailing Address - Fax:951-656-1510
Practice Address - Street 1:25 GEMINI LN
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1707
Practice Address - Country:US
Practice Address - Phone:516-852-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty