Healthcare Provider Details

I. General information

NPI: 1407821804
Provider Name (Legal Business Name): DAVID GHATAVI RUSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MORRIS AVE
ROCKVILLE CENTRE NY
11570-5336
US

IV. Provider business mailing address

PO BOX 9010
ROCKVILLE CENTRE NY
11571-9010
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-1700
  • Fax: 516-763-2734
Mailing address:
  • Phone: 516-763-2735
  • Fax: 516-763-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number232461
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: