| Edward V Kornuszko Psy D Pa | |
|
964 Megano Blvd Deland FL 32724-6502 | |
| (781) 835-5664 | |
| Not Available |
| Full Name | Edward V Kornuszko Psy D Pa |
|---|---|
| Speciality | Psychologist |
| Location | 964 Megano Blvd, Deland, Florida |
| Authorized Official Name and Position | Edward Kornuszko (PRESIDENT) |
| Authorized Official Contact | 7818355664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward V Kornuszko Psy D Pa 964 Megano Blvd Deland FL 32724-6502 Ph: (781) 835-5664 | Edward V Kornuszko Psy D Pa 964 Megano Blvd Deland FL 32724-6502 Ph: (781) 835-5664 |
| NPI Number | 1225748569 |
|---|---|
| Provider Enumeration Date | 11/28/2022 |
| Last Update Date | 08/21/2024 |
| Certification Date | 08/21/2024 |
| Medicare PECOS PAC ID | 0244600435 |
|---|---|
| Medicare Enrollment ID | O20230104002233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225748569 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Edward V Kornuszko |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679982375 PECOS PAC ID: 6204056963 Enrollment ID: I20140930002335 |
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