Provider Demographics
NPI:1700987567
Name:BUSHKUHL, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:BUSHKUHL
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 1:360 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3702
Mailing Address - Country:US
Mailing Address - Phone:845-338-7140
Mailing Address - Fax:845-338-7141
Practice Address - Street 1:360 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3702
Practice Address - Country:US
Practice Address - Phone:845-338-7140
Practice Address - Fax:845-338-7141
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206714208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1749288Medicaid
G48226Medicare UPIN
84Y451Medicare ID - Type Unspecified