Provider Demographics
NPI:1164682407
Name:ZYSKOWSKI, KERI L (NCTMB)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:L
Last Name:ZYSKOWSKI
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 DIANE DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7950
Mailing Address - Country:US
Mailing Address - Phone:908-208-9091
Mailing Address - Fax:
Practice Address - Street 1:70 DIANE DR
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7950
Practice Address - Country:US
Practice Address - Phone:908-208-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ410168-00171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor