Individual
KENNETH H PRUSHIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1994 WELLNESS BLVD STE 110, MONROE, NC 28110-7768
(704) 384-8460
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2018-00935
NC
2080A0000X
Pediatric Adolescent Medicine Physician
228253-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02461633
—
NY
01
—
0600898
GHI
NY
01
—
3C3318
HEALTHNET
NY
01
—
556Y51
BLUE CROSS/ BLUE SHIELD
NY
01
—
P2939540
OXFORD
NY
Enumeration date
08/08/2006
Last updated
08/31/2023
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