Healthcare Provider Details

I. General information

NPI: 1003075755
Provider Name (Legal Business Name): LEON KUSHNIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD STE 4200
NEWARK DE
19713-2075
US

IV. Provider business mailing address

1905 COUNTRY CLUB DR
CHERRY HILL NJ
08003-3315
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-7533
  • Fax: 302-737-7701
Mailing address:
  • Phone: 856-285-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0027264
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA08979400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: