MEDICARE: DR. BRUCE S USHKOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	U3042	TX
2	207P00000X	Emergency Medicine Physician	191365-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013903806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE S USHKOW M.D.

Provider Business Mailing Address
First Line	:	9667 CRYSTAL BEACH RD
Second Line	:
City	:	HAMMONDSPORT
State	:	NY
Zip	:	14840-9341
Country	:	US
Telephone Number	:	607-284-4075
Fax Number	:	607-284-4075

Provider Business Practice Location Address
First Line	:	9667 CRYSTAL BEACH RD
Second Line	:
City	:	HAMMONDSPORT
State	:	NY
Zip	:	14840-9341
Country	:	US
Telephone Number	:	607-284-4075
Fax Number	:	607-284-4075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/27/2023

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