Individual
GIDON COUSSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
94 OLD SHORT HILLS RD, LIVINGSTON, NJ 07039-5672
(973) 322-5000
Mailing address
66 BROWNING RD, SHORT HILLS, NJ 07078-1142
(917) 478-3951
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25MP00525000
NJ
363A00000X
Physician Assistant
Primary
25MP00525000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00525000
NJ PA LICENSE
NJ
Enumeration date
06/19/2019
Last updated
05/29/2020
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