Provider Demographics
NPI:1134104805
Name:KUSHNER, STEPHEN J (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 YORKLYN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8744
Mailing Address - Country:US
Mailing Address - Phone:302-234-5770
Mailing Address - Fax:302-234-5777
Practice Address - Street 1:726 YORKLYN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8744
Practice Address - Country:US
Practice Address - Phone:302-234-5770
Practice Address - Fax:302-234-5777
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10004594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE694433C90Medicare PIN
DE694433F29Medicare PIN
DEF03560Medicare UPIN