Provider Demographics
NPI:1871855726
Name:KUSHNIR, RENATA (MSED)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:KUSHNIR
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 OCEAN PKWY
Mailing Address - Street 2:7K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7759
Mailing Address - Country:US
Mailing Address - Phone:646-496-3666
Mailing Address - Fax:347-587-3010
Practice Address - Street 1:2650 OCEAN PKWY
Practice Address - Street 2:7K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7759
Practice Address - Country:US
Practice Address - Phone:646-496-3666
Practice Address - Fax:347-587-3010
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY595297121174400000X
NY595296121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist