Provider Demographics
NPI:1235978784
Name:HUSCH, STEPHEN DONALD
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DONALD
Last Name:HUSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1326
Mailing Address - Country:US
Mailing Address - Phone:842-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:1 SPRINGFIELD AVE FL 3
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4055
Practice Address - Country:US
Practice Address - Phone:908-934-0555
Practice Address - Fax:908-934-0556
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00842400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant