Provider Demographics
NPI:1851354773
Name:DUSHEY, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:DUSHEY
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 1:14 SOUNDVIEW AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3327
Mailing Address - Country:US
Mailing Address - Phone:914-949-5770
Mailing Address - Fax:914-949-5573
Practice Address - Street 1:14 SOUNDVIEW AVE
Practice Address - Street 2:APT 1
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-3327
Practice Address - Country:US
Practice Address - Phone:914-949-5770
Practice Address - Fax:914-949-5573
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109659207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY221689SJOtherWORKERS COMP
NY00543375Medicaid
NY221689SJOtherWORKERS COMP
C12531Medicare UPIN