Healthcare Provider Details

I. General information

NPI: 1801556725
Provider Name (Legal Business Name): ALEXANDER ZHUSHMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

IV. Provider business mailing address

32 CHEYENNE CRES
WHITESBORO NY
13492-2926
US

V. Phone/Fax

Practice location:
  • Phone: 800-748-3243
  • Fax:
Mailing address:
  • Phone: 315-941-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number694037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: