Individual
KENNETH H PRUSHIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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