Provider Demographics
NPI:1568400927
Name:KUSHINS, PHYLLIS FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:FRANK
Last Name:KUSHINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:138 FRESH PONDS RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2408
Mailing Address - Country:US
Mailing Address - Phone:732-297-3438
Mailing Address - Fax:732-297-3438
Practice Address - Street 1:300 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5589
Practice Address - Country:US
Practice Address - Phone:609-409-1363
Practice Address - Fax:609-409-9493
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7277105Medicaid
NJ761205B3LMedicare ID - Type Unspecified
NJ7277105Medicaid