Provider Demographics
NPI:1689747677
Name:KUSHNIR, SEYMOUR LARRY (MD)
Entity Type:Individual
Prefix:
First Name:SEYMOUR
Middle Name:LARRY
Last Name:KUSHNIR
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 1:20 GRAND STREET
Mailing Address - Street 2:3RD FL
Mailing Address - City:WARWICK
Mailing Address - State:NEW YORK
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:UM
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:255 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-987-3973
Practice Address - Fax:845-987-5979
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1991132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02362843Medicaid
NY02753533Medicaid
3054V1OtherEMPIRE BCBS
NY272BDFW351Medicare PIN
3054V1OtherEMPIRE BCBS