Provider Demographics
NPI:1093783615
Name:KUSHNER, SUSAN CUSHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CUSHMAN
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 FOREST AVE
Mailing Address - Street 2:PENTHOUSE SUITE
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5424
Mailing Address - Country:US
Mailing Address - Phone:201-267-0888
Mailing Address - Fax:201-483-8874
Practice Address - Street 1:299 FOREST AVE
Practice Address - Street 2:PENTHOUSE SUITE
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5424
Practice Address - Country:US
Practice Address - Phone:201-267-0888
Practice Address - Fax:201-483-8874
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics