Healthcare Provider Details

I. General information

NPI: 1396171641
Provider Name (Legal Business Name): ERWIN RUSLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 59TH ST W STE 2200
BRADENTON FL
34209-4689
US

IV. Provider business mailing address

100 WOODS RD
VALHALLA NY
10595-1530
US

V. Phone/Fax

Practice location:
  • Phone: 941-794-5621
  • Fax: 941-761-1532
Mailing address:
  • Phone: 914-493-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number130955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: