Healthcare Provider Details

I. General information

NPI: 1245645670
Provider Name (Legal Business Name): CRISTINA RUSU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 07/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH ST STE 101
GENEVA NY
14456-1561
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5100
  • Fax:
Mailing address:
  • Phone: 585-922-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number289676
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number289676
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number289676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: