Provider Demographics
NPI:1568795045
Name:KUSTIN, NORA
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:KUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 BLONDELL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2601
Mailing Address - Country:US
Mailing Address - Phone:718-239-9808
Mailing Address - Fax:718-239-3523
Practice Address - Street 1:1515 BLONDELL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2601
Practice Address - Country:US
Practice Address - Phone:718-239-9808
Practice Address - Fax:718-239-3523
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist