Provider Demographics
NPI:1275310641
Name:KRUSINSKI, CORY JOSEPH
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:JOSEPH
Last Name:KRUSINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8166 WREN DR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2127
Mailing Address - Country:US
Mailing Address - Phone:216-225-6336
Mailing Address - Fax:
Practice Address - Street 1:8166 WREN DR
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2127
Practice Address - Country:US
Practice Address - Phone:216-225-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86075564133V00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No374U00000XNursing Service Related ProvidersHome Health Aide