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General NPI Number Information
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NPI Number | 1922480102
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Entity Type | Organization
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Legal Business Name | JUSTIN SCHUSSHEIM DDS PC
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 71 TODT HILL RD SUITE 203
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4510
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Country | US
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Telephone | 718-816-8102
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Fax | 718-816-0769
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Provider Business Mailing Address
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Address Line | 71 TODT HILL RD SUITE 203
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4510
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Country | US
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Telephone | 718-816-8102
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Fax | 718-816-0769
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN SCHUSHEIM
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Credential | DDS
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Telephone | 516-509-4732
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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 | 056152
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License Number State | NY
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