Provider Demographics
NPI:1942283858
Name:CUSHMAN, JEFFREY D (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:CUSHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-517-8006
Mailing Address - Fax:631-517-8007
Practice Address - Street 1:7901 SCHATZ POINTE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3856
Practice Address - Country:US
Practice Address - Phone:937-439-0390
Practice Address - Fax:937-439-7370
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003697C2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0658300Medicaid
OH4061734Medicare PIN
E41398Medicare UPIN
OH4061737Medicare PIN
OH4061733Medicare PIN
OH0658300Medicaid
OH4061735Medicare PIN