Provider Demographics
NPI:1992754410
Name:KUSHNICK, STEVEN DAVID (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:KUSHNICK
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 1:10 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6002
Mailing Address - Country:US
Mailing Address - Phone:718-250-8520
Mailing Address - Fax:914-725-2739
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8520
Practice Address - Fax:718-250-6327
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178322207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01454920Medicaid
NY02I48E9681Medicare PIN