Provider Demographics
NPI:1457782054
Name:KUSI, GORDON (APN)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:
Last Name:KUSI
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 COUNTY ROAD 601
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-3923
Mailing Address - Country:US
Mailing Address - Phone:908-281-1762
Mailing Address - Fax:908-281-1321
Practice Address - Street 1:252 COUNTY ROAD 601
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-3923
Practice Address - Country:US
Practice Address - Phone:908-281-1762
Practice Address - Fax:908-281-1321
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00479500363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0454664Medicare Oscar/Certification