Provider Demographics
NPI:1700840758
Name:NUSCHKE, RANDELL A (MD)
Entity type:Individual
Prefix:
First Name:RANDELL
Middle Name:A
Last Name:NUSCHKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:2087 ROUTE 9 STE 9
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:NJ
Practice Address - Zip Code:08230-1148
Practice Address - Country:US
Practice Address - Phone:609-486-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1492207R00000X
NJ25MA04738500207R00000X
NC200400287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0108388000OtherAMERIHEALTH
NJ3874206Medicaid
NJ3874206Medicaid
273587OtherUNITED HEALTHCARE
36076OtherAETNA INC.
1K0922OtherHEALTH NET
P11044190OtherMULTIPLAN
9694773OtherGHI
C56441Medicare UPIN
J3922OtherHORIZON BCBS OF NJ
77345OtherPRIVATE HEALTHCARE SYSTEM
223602508OtherGROUP TAX ID#
0108388000OtherAMERIHEALTH
1325066OtherFIRST HEALTH
NJ3874206Medicaid
1043780OtherHORIZON NJ HEALTH
481312Medicare ID - Type Unspecified