Provider Demographics
NPI:1871676262
Name:KUSHCH, ALEXANDER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KUSHCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 W STATE ROAD 84
Mailing Address - Street 2:NO. 113
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4456
Mailing Address - Country:US
Mailing Address - Phone:954-296-1048
Mailing Address - Fax:954-981-9443
Practice Address - Street 1:5353 N FEDERAL HWY
Practice Address - Street 2:STE 207
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3236
Practice Address - Country:US
Practice Address - Phone:954-296-1048
Practice Address - Fax:954-981-9443
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1940Medicare ID - Type UnspecifiedPART B PROVIDER
FLE1940ZMedicare UPIN