Provider Demographics
NPI:1215416805
Name:ZUSIN, ALEX (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:ZUSIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 BATCHELDER ST APT 5O
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1530
Mailing Address - Country:US
Mailing Address - Phone:718-419-1435
Mailing Address - Fax:
Practice Address - Street 1:2540 BATCHELDER ST APT 5O
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1530
Practice Address - Country:US
Practice Address - Phone:718-419-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty