Provider Demographics
NPI:1841559812
Name:RICHARD M KUSHNER, DPM, LLC
Entity Type:Organization
Organization Name:RICHARD M KUSHNER, DPM, LLC
Other - Org Name:RICHARD M. KUSHNER DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-355-2875
Mailing Address - Street 1:580 PARK AVENUE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7313
Mailing Address - Country:US
Mailing Address - Phone:212-355-2875
Mailing Address - Fax:212-355-0537
Practice Address - Street 1:580 PARK AVENUE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7313
Practice Address - Country:US
Practice Address - Phone:212-355-2875
Practice Address - Fax:212-355-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002333213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50739Medicare UPIN