Basic Information
| Provider Information | |||||||||
| NPI: | 1821371360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUSKIN | ||||||||
| FirstName: | CONOR | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE | ||||||||
| Address2: | BUILDING 1300 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096776060 | ||||||||
| FaxNumber: | 6096776061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE | ||||||||
| Address2: | BUILDING 1300 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096776060 | ||||||||
| FaxNumber: | 6096776061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2011 | ||||||||
| LastUpdateDate: | 03/30/2012 | ||||||||
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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 | 363A00000X | MA055156 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | OA002732 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 25MP00281800 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.