NPI 1790224319

Dylan Zera-Krushinski, LATATC

Practitioner Prevention Professional Montclair, NJ

Practice location

Address: 1 Normal Ave, Montclair, NJ 07043-1624
Phone: (973) 655-5250
Mailing address: 510 Miller St # 3, Perth Amboy, NJ 08861-3474

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 25MT00221400 (NJ)

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Registry record

NPI: 1790224319
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Feb 2017
Record last updated: 15 Feb 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.