Provider Demographics
NPI:1669455259
Name:KUSHEL, STUART WARREN (DPM)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:WARREN
Last Name:KUSHEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SCHALKS CROSSING ROAD
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1612
Mailing Address - Country:US
Mailing Address - Phone:609-275-7272
Mailing Address - Fax:609-275-8028
Practice Address - Street 1:10 SCHALKS CROSSING ROAD
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1612
Practice Address - Country:US
Practice Address - Phone:609-275-7272
Practice Address - Fax:609-275-8028
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2011-10-13
Deactivation Date:2008-02-20
Deactivation Code:
Reactivation Date:2008-05-07
Provider Licenses
StateLicense IDTaxonomies
NJ25MD001212213E00000X
NJ25MD00121200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0837601Medicaid
416909Medicare PIN
NJ0837601Medicaid
580222Medicare PIN
3902240001Medicare NSC