Healthcare Provider Details

I. General information

NPI: 1821754938
Provider Name (Legal Business Name): RICHARD KUSHAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 GLEN COVE AVE
SEA CLIFF NY
11579-1455
US

IV. Provider business mailing address

207 GLEN COVE AVE
SEA CLIFF NY
11579-1455
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-1742
  • Fax: 516-676-9662
Mailing address:
  • Phone: 516-676-1742
  • Fax: 516-676-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012240
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: