Provider Demographics
NPI:1669730958
Name:KUSHNER, JARED SCOTT
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:SCOTT
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-342-0619
Mailing Address - Fax:212-305-6307
Practice Address - Street 1:177 FT. WASHINGTON AVE
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-342-0619
Practice Address - Fax:212-305-6307
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276873207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine