Provider Demographics
NPI:1326125493
Name:ZDYRSKI, JOSEPH G (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:ZDYRSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 FRANKLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-759-1702
Mailing Address - Fax:973-759-2399
Practice Address - Street 1:441 FRANKLIN AVENUE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109
Practice Address - Country:US
Practice Address - Phone:973-759-1702
Practice Address - Fax:973-759-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00299300111N00000X
NYX004260-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2104300-01Medicaid
NJ22-2765343OtherEIN NUMBER
NJ2104300-01Medicaid
NJ22-2765343OtherEIN NUMBER