Provider Demographics
NPI:1790224319
Name:ZERA-KRUSHINSKI, DYLAN (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:
Last Name:ZERA-KRUSHINSKI
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:MR
Other - First Name:DYLAN
Other - Middle Name:
Other - Last Name:KRUSHINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:510 MILLER ST # 3
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3474
Mailing Address - Country:US
Mailing Address - Phone:732-794-3892
Mailing Address - Fax:
Practice Address - Street 1:1 NORMAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1624
Practice Address - Country:US
Practice Address - Phone:973-655-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00221400405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional