Provider Demographics
NPI:1083229165
Name:KUSHER FUNCTIONAL MEDICINE CENTER PC
Entity type:Organization
Organization Name:KUSHER FUNCTIONAL MEDICINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-214-0815
Mailing Address - Street 1:76 EASTERN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4382
Mailing Address - Country:US
Mailing Address - Phone:800-735-2281
Mailing Address - Fax:888-519-2097
Practice Address - Street 1:76 EASTERN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4382
Practice Address - Country:US
Practice Address - Phone:800-735-2281
Practice Address - Fax:888-519-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center