Healthcare Provider Details

I. General information

NPI: 1922584549
Provider Name (Legal Business Name): KATHRYN DZURILLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E 34TH ST
NEW YORK NY
10016-4901
US

IV. Provider business mailing address

20 YORK ST. CB-2041
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 347-802-5853
  • Fax:
Mailing address:
  • Phone: 203-688-4748
  • Fax: 203-688-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7681
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF431583-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: