Basic Information
| Provider Information | |||||||||
| NPI: | 1689747677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUSHNIR | ||||||||
| FirstName: | SEYMOUR | ||||||||
| MiddleName: | LARRY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 GRAND STREET | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | WARWICK | ||||||||
| State: | NEW YORK | ||||||||
| PostalCode: | 109901035 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 8459873906 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459873973 | ||||||||
| FaxNumber: | 8459875979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 05/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 199113 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 02362843 | 05 | NY | MEDICAID | 02753533 | 05 | NY | MEDICAID | 3054V1 | 01 | EMPIRE BCBS | OTHER |