Healthcare Provider Details

I. General information

NPI: 1124156385
Provider Name (Legal Business Name): ZUSIN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 GRANT AVE
PELHAM NY
10803-3440
US

IV. Provider business mailing address

1140 GRANT AVE
PELHAM NY
10803-3440
US

V. Phone/Fax

Practice location:
  • Phone: 917-968-5238
  • Fax: 914-533-3443
Mailing address:
  • Phone: 917-968-5238
  • Fax: 914-533-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number54364
License Number StateCA

VIII. Authorized Official

Name: DR. OLEG ZUSIN
Title or Position: OWNER
Credential: D.D.S.
Phone: 917-968-5238