Basic Information
| Provider Information | |||||||||
| NPI: | 1578553848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZUSKY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MATTHEW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ZUSKY | ||||||||
| OtherFirstName: | PAUL | ||||||||
| OtherMiddleName: | MATTHEW | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 9142 | ||||||||
| Address2: | MASS GENERAL PHYSICIAN ORGANIZATION | ||||||||
| City: | CHARLESTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021299142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177245600 | ||||||||
| FaxNumber: | 6177267541 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 PARKMAN ST | ||||||||
| Address2: | WAC 8 PSYCHIATRY-OUTPATIENT DEPART | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021143117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177245600 | ||||||||
| FaxNumber: | 6177267541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 47479 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2084P0800X | 47479 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | B02126 | 01 | MA | BCBS MA | OTHER | 715489 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 2088495 | 05 | MA | MEDICAID |