Provider Demographics
NPI:1558446070
Name:KUSNETZ, MARTIN AARON (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:AARON
Last Name:KUSNETZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5 LONNIE CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4091
Mailing Address - Country:US
Mailing Address - Phone:732-257-2539
Mailing Address - Fax:
Practice Address - Street 1:5818 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3820
Practice Address - Country:US
Practice Address - Phone:718-439-8440
Practice Address - Fax:718-439-7063
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003016-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT81439Medicare UPIN