Provider Demographics
NPI:1093024606
Name:HYPNOSCOPE MEDICAL, PC
Entity Type:Organization
Organization Name:HYPNOSCOPE MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-278-5223
Mailing Address - Street 1:667 STONELEIGH AVE
Mailing Address - Street 2:BUILDING A, SUITE #201
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2454
Mailing Address - Country:US
Mailing Address - Phone:845-278-5223
Mailing Address - Fax:845-494-4775
Practice Address - Street 1:667 STONELEIGH AVE
Practice Address - Street 2:BUILDING A, SUITE #201
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2454
Practice Address - Country:US
Practice Address - Phone:845-278-5223
Practice Address - Fax:845-494-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187652174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100046483Medicare PIN