Provider Demographics
NPI:1578604823
Name:SZYCH, JERRY RAYMOND (NP, DC, RN)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RAYMOND
Last Name:SZYCH
Suffix:
Gender:M
Credentials:NP, DC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ADAMSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3029
Mailing Address - Country:US
Mailing Address - Phone:908-553-3919
Mailing Address - Fax:908-393-1412
Practice Address - Street 1:290 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3742
Practice Address - Country:US
Practice Address - Phone:908-553-3919
Practice Address - Fax:908-393-1412
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00411000111N00000X
NY350690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ408783Medicare ID - Type Unspecified