Healthcare Provider Details

I. General information

NPI: 1063954543
Provider Name (Legal Business Name): ANDREW GUSHEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 AVENUE OF AMERICAS AT NEW YORK SPORTS CLUB
NEW YORK NY
10020-1001
US

IV. Provider business mailing address

1221 AVENUE OF AMERICAS AT NEW YORK SPORTS CLUB
NEW YORK NY
10020
US

V. Phone/Fax

Practice location:
  • Phone: 646-562-0617
  • Fax: 914-315-1799
Mailing address:
  • Phone: 646-562-0617
  • Fax: 914-315-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: