MEDICARE: CHRISTINE M CHRUSCICKI M.D.

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
1	2084P0804X	Child & Adolescent Psychiatry Physician	223997	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00027081901	OTHER	NY	UNIVERA
2	1590756	OTHER	NY	INDEPENDENT HEALTH
3	000528078001	OTHER	NY	HEALTH INTEGRATED
4	10696776	OTHER	NY	CAQH

General Provider Information

NPI Number	:	1922001734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE M CHRUSCICKI M.D.

Provider Business Mailing Address
First Line	:	100 PINEWILD DR
Second Line	:	SUITE 2A
City	:	ROCHESTER
State	:	NY
Zip	:	14606-4200
Country	:	US
Telephone Number	:	585-368-6700
Fax Number	:	585-368-6767

Provider Business Practice Location Address
First Line	:	100 PINEWILD DR
Second Line	:	SUITE 2A
City	:	ROCHESTER
State	:	NY
Zip	:	14606-4200
Country	:	US
Telephone Number	:	585-368-6700
Fax Number	:	585-368-6767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/10/2007

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