Provider Demographics
NPI:1245919711
Name:YUZVYAK, ANDRIY (DDS)
Entity type:Individual
Prefix:
First Name:ANDRIY
Middle Name:
Last Name:YUZVYAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 UNIVERSITY PLACE BLVD APT 113
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4663
Mailing Address - Country:US
Mailing Address - Phone:718-360-7182
Mailing Address - Fax:
Practice Address - Street 1:33 UNIVERSITY PLACE BLVD APT 113
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-4663
Practice Address - Country:US
Practice Address - Phone:718-360-7182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02995200122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program