MEDICARE: MICHAEL B. KUSHNER DDS 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	1223G0001X	General Practice Dentistry	034349	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255599908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL B. KUSHNER DDS PC

Provider Business Mailing Address
First Line	:	1340 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2002
Country	:	US
Telephone Number	:	718-442-4440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL B KUSHNER
Credential	:
Telephone Number	:	718-442-4440

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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