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NPI Code Detail

MEDICARE: MR. ANDREY RUSETSKIY LMSW

MEDICARE: MR. ANDREY RUSETSKIY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1053586289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREY RUSETSKIY LMSW
Provider Business Mailing Address
First Line : 116 JOHN ST FL 27
Second Line :
City : NEW YORK
State : NY
Zip : 10038-3414
Country : US
Telephone Number : 212-385-0086
Fax Number : 212-732-0757
Provider Business Practice Location Address
First Line : 116 JOHN ST FL 27
Second Line :
City : NEW YORK
State : NY
Zip : 10038-3414
Country : US
Telephone Number : 212-385-0086
Fax Number : 212-732-0757
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2008
Last Update Date : 08/12/2008

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