Healthcare Provider Details

I. General information

NPI: 1750300539
Provider Name (Legal Business Name): MICHAEL STUART KUSHNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE BARNS OFFICE CENTER BLDG A201
CARMEL NY
10512-2454
US

IV. Provider business mailing address

14 MANCINI DR
YORKTOWN HEIGHTS NY
10598-6435
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-5223
  • Fax: 845-278-4579
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1876521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: