Provider Demographics
NPI:1265501217
Name:KUSHNIR, MARUSIA E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARUSIA
Middle Name:E
Last Name:KUSHNIR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MILLBURN AVE.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1942
Mailing Address - Country:US
Mailing Address - Phone:973-467-9876
Mailing Address - Fax:973-379-1440
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1942
Practice Address - Country:US
Practice Address - Phone:973-467-9876
Practice Address - Fax:973-379-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020505001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice