Provider Demographics
NPI:1386249860
Name:ZERAMBY, JUSTIN STEPHEN (PA-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:STEPHEN
Last Name:ZERAMBY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 USQUEPAUGH RD
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1923
Mailing Address - Country:US
Mailing Address - Phone:401-575-2839
Mailing Address - Fax:
Practice Address - Street 1:1524 ATWOOD AVE STE 220
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3288
Practice Address - Country:US
Practice Address - Phone:401-272-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant