Provider Demographics
NPI:1528057627
Name:KASHUK, JEFFRY (MD)
Entity type:Individual
Prefix:
First Name:JEFFRY
Middle Name:
Last Name:KASHUK
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 1:17 ALGONQUIN CIR
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-5231
Mailing Address - Country:US
Mailing Address - Phone:303-653-5700
Mailing Address - Fax:
Practice Address - Street 1:17 ALGONQUIN CIR
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-5231
Practice Address - Country:US
Practice Address - Phone:303-653-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045576L2086S0127X, 207Q00000X
NY258763207Q00000X
MN62972207Q00000X
MI4301088604207Q00000X
AZ13452207Q00000X
MDD71309207Q00000X
CODR.0023623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D24301Medicare UPIN
PA697803Medicare ID - Type Unspecified