MEDICARE: DR. MICHAEL BRUCE KUSHNER DDS

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	1223G0001X	General Practice Dentistry	034349	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	:	1578552592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRUCE KUSHNER DDS

Provider Business Mailing Address
First Line	:	15 DEMAREST DR
Second Line	:
City	:	MENDHAM
State	:	NJ
Zip	:	07945-1524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2002
Country	:	US
Telephone Number	:	718-442-4440
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/09/2007

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