Provider Demographics
NPI:1518967769
Name:CHUSID, BORIS G (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:G
Last Name:CHUSID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HIGH WOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417
Mailing Address - Country:US
Mailing Address - Phone:201-289-1121
Mailing Address - Fax:201-560-1695
Practice Address - Street 1:700 HIGH WOODS DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2255
Practice Address - Country:US
Practice Address - Phone:201-289-1121
Practice Address - Fax:201-560-1695
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY206310207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02178774Medicaid
NY2178774Medicaid
NY02178774Medicaid
H42710Medicare UPIN
NY2178774Medicaid
NYH42710Medicare PIN