Healthcare Provider Details

I. General information

NPI: 1538689567
Provider Name (Legal Business Name): JASON KUSHNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RIVINGTON ST
NEW YORK NY
10002-1304
US

IV. Provider business mailing address

45 RIVINGTON ST # 5R
NEW YORK NY
10002-1304
US

V. Phone/Fax

Practice location:
  • Phone: 332-243-1600
  • Fax:
Mailing address:
  • Phone: 332-243-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number303018
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number303018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: