Provider Demographics
NPI:1932269354
Name:KUSNIERZ, JAMES LARRY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LARRY
Last Name:KUSNIERZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3605
Mailing Address - Country:US
Mailing Address - Phone:973-399-8777
Mailing Address - Fax:973-443-0267
Practice Address - Street 1:855 GROVE ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3605
Practice Address - Country:US
Practice Address - Phone:973-399-8777
Practice Address - Fax:973-443-0267
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03634200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3168808Medicaid
NJ3168808Medicaid
NJKU467666Medicare ID - Type Unspecified