Provider Demographics
NPI:1538250444
Name:ZYSIK, EDMUND T JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:T
Last Name:ZYSIK
Suffix:JR
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 1:67 E ORVIS ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-2007
Mailing Address - Country:US
Mailing Address - Phone:315-764-1867
Mailing Address - Fax:315-764-1093
Practice Address - Street 1:67 E ORVIS ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2007
Practice Address - Country:US
Practice Address - Phone:315-764-1867
Practice Address - Fax:315-764-1093
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist