Provider Demographics
NPI:1609080993
Name:GUSHUE, GEORGE V (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:V
Last Name:GUSHUE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 120TH ST
Mailing Address - Street 2:TEACHERS COLLEGE (BOX 64)
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6625
Mailing Address - Country:US
Mailing Address - Phone:212-687-3170
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:NEW YORK PRESBYTERIAN HOSPITAL (EYE-6)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13215103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVN0361Medicare ID - Type UnspecifiedEMPIRE MEDICARE PROVIDER#