Healthcare Provider Details

I. General information

NPI: 1003878570
Provider Name (Legal Business Name): DEBORAH A. HRUSTICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NORTHERN BLVD SUITE 105
ALBANY NY
12204-1000
US

IV. Provider business mailing address

350 NORTHERN BLVD SUITE 105
ALBANY NY
12204-1000
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-1850
  • Fax: 518-518-5287
Mailing address:
  • Phone: 518-446-1850
  • Fax: 518-518-5287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number161491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: