Provider Demographics
NPI:1376720375
Name:STUART KUSHEL
Entity Type:Organization
Organization Name:STUART KUSHEL
Other - Org Name:STUART W. KUSHEL DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:W
Authorized Official - Last Name:KUSHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-275-7272
Mailing Address - Street 1:10 SCHALKS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1612
Mailing Address - Country:US
Mailing Address - Phone:609-275-7272
Mailing Address - Fax:609-275-8028
Practice Address - Street 1:10 SCHALKS CROSSING RD
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1612
Practice Address - Country:US
Practice Address - Phone:609-275-7272
Practice Address - Fax:609-275-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00121200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0837601Medicaid
3902240001Medicare NSC
416909Medicare PIN
NJ0837601Medicaid