Healthcare Provider Details

I. General information

NPI: 1740307453
Provider Name (Legal Business Name): KELLY RUSINEK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 70TH ST STARR 409
NEW YORK NY
10021-9800
US

IV. Provider business mailing address

1320 YORK AVE APT 18F
NEW YORK NY
10021-4800
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number302742
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: