Provider Demographics
NPI:1700840758
Name:NUSCHKE, RANDELL A (MD)
Entity Type:Individual
Prefix:
First Name:RANDELL
Middle Name:A
Last Name:NUSCHKE
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:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210
Mailing Address - Country:US
Mailing Address - Phone:609-967-0070
Mailing Address - Fax:609-967-0077
Practice Address - Street 1:336 96TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:STONE HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08247-1439
Practice Address - Country:US
Practice Address - Phone:609-967-0070
Practice Address - Fax:609-967-0077
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04738500207R00000X
NC200400287207R00000X
VI1492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0108388000OtherAMERIHEALTH
NJ3874206Medicaid
NJ3874206Medicaid
273587OtherUNITED HEALTHCARE
36076OtherAETNA INC.
1K0922OtherHEALTH NET
P11044190OtherMULTIPLAN
9694773OtherGHI
C56441Medicare UPIN
J3922OtherHORIZON BCBS OF NJ
77345OtherPRIVATE HEALTHCARE SYSTEM
223602508OtherGROUP TAX ID#
0108388000OtherAMERIHEALTH
1325066OtherFIRST HEALTH
NJ3874206Medicaid
1043780OtherHORIZON NJ HEALTH
481312Medicare ID - Type Unspecified