Healthcare Provider Details

I. General information

NPI: 1508912973
Provider Name (Legal Business Name): JAMES CHESTER RUCINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

506 6TH ST
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3288
  • Fax: 718-780-3154
Mailing address:
  • Phone: 718-780-3288
  • Fax: 718-780-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number171852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: