Provider Demographics
NPI:1245424506
Name:TERUSHKIN, SERGEY (MD)
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:TERUSHKIN
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 1:331 NEWMAN SPRINGS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5792
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:3537 FOREST HILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5867
Practice Address - Country:US
Practice Address - Phone:561-892-6002
Practice Address - Fax:561-892-6001
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09461900208600000X
NY262892208600000X
FLME107293208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03378925Medicaid
NY03378925Medicaid