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General NPI Number Information
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NPI Number | 1235978784
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Entity Type | Individual
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Provider Name | STEPHEN DONALD HUSCH
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Gender | Male
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 1 SPRINGFIELD AVE FL 3
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City | SUMMIT
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State | NJ
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Zip | 07901-4055
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Country | US
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Telephone | 908-934-0555
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Fax | 908-934-0556
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Provider Business Mailing Address
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Address Line | PO BOX 416457
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City | BOSTON
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State | MA
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Zip | 02241-1326
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Country | US
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Telephone | 842-362-1735
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Fax | 973-290-7495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00842400
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License Number State | NJ
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