MEDICARE: NINA KUSHNER MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1215095823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NINA KUSHNER MEDICAL PC

Provider Business Mailing Address
First Line	:	4513 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2107
Country	:	US
Telephone Number	:	718-633-9191
Fax Number	:	718-633-6661

Provider Business Practice Location Address
First Line	:	4513 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2107
Country	:	US
Telephone Number	:	718-633-9191
Fax Number	:	718-633-6661

Authorized Official
Title or Position	:	OWNER
Name	:	NINA KUSHNER
Credential	:	MD
Telephone Number	:	718-633-9191

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	01/11/2008

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