Provider Demographics
NPI:1104800218
Name:MUSHER, DAVID REUBEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:REUBEN
Last Name:MUSHER
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 1:1158 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6917
Mailing Address - Country:US
Mailing Address - Phone:212-410-0004
Mailing Address - Fax:212-534-8539
Practice Address - Street 1:1158 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6917
Practice Address - Country:US
Practice Address - Phone:212-410-0004
Practice Address - Fax:212-534-8539
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104154207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY180992Medicaid
NY626371Medicare ID - Type Unspecified
NY180992Medicaid