Provider Demographics
NPI:1396798526
Name:VAN KUST, BIANCA D (MD)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:D
Last Name:VAN KUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2808
Mailing Address - Country:US
Mailing Address - Phone:845-452-1700
Mailing Address - Fax:
Practice Address - Street 1:2044 WESTCHESTER AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4559
Practice Address - Country:US
Practice Address - Phone:646-680-5200
Practice Address - Fax:646-751-6937
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7390734OtherAETNA PPO
PA1770598OtherHIGHMARK BLUE SHIELD
PA36454-MD426811OtherHEALTH PARTNERS
PA1132468OtherAETNA HMO
PA2452354000OtherAMERIHEALTH/INTERCOUNTY
PA1014409450001Medicaid
PA2452354000OtherIBC - PC/KHPE
PA30027404OtherKEYSTONE MERCY