Provider Demographics
NPI:1609032374
Name:ZYSK, EWA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:EWA
Middle Name:
Last Name:ZYSK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-2302
Mailing Address - Country:US
Mailing Address - Phone:917-577-4016
Mailing Address - Fax:
Practice Address - Street 1:268 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3347
Practice Address - Country:US
Practice Address - Phone:516-378-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist