Provider Demographics
NPI:1891564159
Name:MCCUSKER, TOM J
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:J
Last Name:MCCUSKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BOOTS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6338
Mailing Address - Country:US
Mailing Address - Phone:914-420-5816
Mailing Address - Fax:
Practice Address - Street 1:500 OAKBROOK LN STE 201
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8293
Practice Address - Country:US
Practice Address - Phone:843-970-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach