Provider Demographics
NPI:1407944978
Name:KUSHNER, RICHARD MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 PARK AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7313
Mailing Address - Country:US
Mailing Address - Phone:212-355-2875
Mailing Address - Fax:212-355-0537
Practice Address - Street 1:580 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7313
Practice Address - Country:US
Practice Address - Phone:212-355-2875
Practice Address - Fax:212-355-0537
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002333213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T50739Medicare UPIN