Provider Demographics
NPI:1740592385
Name:KAUSHESH, MOHINI
Entity Type:Individual
Prefix:MRS
First Name:MOHINI
Middle Name:
Last Name:KAUSHESH
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 1:62 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2409
Mailing Address - Country:US
Mailing Address - Phone:631-243-1072
Mailing Address - Fax:
Practice Address - Street 1:62 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2409
Practice Address - Country:US
Practice Address - Phone:631-243-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007699-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY007699-1OtherNYS LICENSE