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General NPI Number Information
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NPI Number | 1255599908
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Entity Type | Organization
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Legal Business Name | MICHAEL B. KUSHNER DDS PC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 1340 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2002
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Country | US
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Telephone | 718-442-4440
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-2002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL B KUSHNER
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Credential |
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Telephone | 718-442-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 034349
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License Number State | NY
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