Provider Demographics
NPI:1750304937
Name:SHUSTIK, OFER J (MD)
Entity Type:Individual
Prefix:
First Name:OFER
Middle Name:J
Last Name:SHUSTIK
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 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:610-861-0854
Practice Address - Street 1:1411 N FLAGLER DR STE 7000
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3418
Practice Address - Country:US
Practice Address - Phone:561-283-2925
Practice Address - Fax:561-791-6936
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD060864L207Q00000X
FLME132238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42871Medicare UPIN
PA643242Medicare ID - Type Unspecified
NJ050381Medicare ID - Type Unspecified