Provider Demographics
NPI:1326257437
Name:JERRY SZYCH
Entity Type:Organization
Organization Name:JERRY SZYCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NABEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-966-2464
Mailing Address - Street 1:71 LIVINGSTON AVE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2523
Mailing Address - Country:US
Mailing Address - Phone:732-565-1701
Mailing Address - Fax:
Practice Address - Street 1:71 LIVINGSTON AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2523
Practice Address - Country:US
Practice Address - Phone:732-565-1701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00411000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU38601Medicare UPIN