Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 269929 | NY |
NPI | 1003130527 |
---|---|
Provider Name | Dr. Matthew Kusher |
First Address | Corona, NY 11368-2025 |
Second Address | Corona, NY 11368-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2010 |
Last Update Date | 20/09/2013 |