Provider Demographics
NPI:1417208364
Name:PETRYSHYN, ZINOVIYA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ZINOVIYA
Middle Name:
Last Name:PETRYSHYN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3901
Mailing Address - Country:US
Mailing Address - Phone:201-725-4963
Mailing Address - Fax:
Practice Address - Street 1:347 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2744
Practice Address - Country:US
Practice Address - Phone:973-571-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00290700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant