Basic Information
Provider Information | |||||||||
NPI: | 1518046465 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JUSINSKI | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | G. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2775 SCHOENERSVILLE RD | ||||||||
Address2: |   | ||||||||
City: | BETHLEHEM | ||||||||
State: | PA | ||||||||
PostalCode: | 180177307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6108618080 | ||||||||
FaxNumber: | 6108070366 | ||||||||
Practice Location | |||||||||
Address1: | 135 LAFAYETTE AVE | ||||||||
Address2: |   | ||||||||
City: | PALMERTON | ||||||||
State: | PA | ||||||||
PostalCode: | 180711518 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4848225320 | ||||||||
FaxNumber: | 4848225321 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/03/2006 | ||||||||
LastUpdateDate: | 08/14/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | MD429684 | PA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | 50073442 | 01 |   | CAPITAL BLUE CROSS | OTHER | 9571068 | 01 |   | AETNA - PPO | OTHER | 113835 | 01 |   | GEISINGER HEALTH PLAN | OTHER | 1985190 | 01 |   | HIGHMARK BLUE SHIELD | OTHER | 732955 | 01 |   | HEALTH AMERICA/HEALTH ASSURANCE | OTHER | 50073442 | 01 |   | KEYSTONE HEALTH PLAN CENTRAL | OTHER | 3120202 | 01 |   | CIGNA HEALTHCARE | OTHER | 1749244 | 01 |   | AETNA - HMO | OTHER | 2840104 | 01 |   | UNITED HEALTHCARE | OTHER |