Healthcare Provider Details

I. General information

NPI: 1770585549
Provider Name (Legal Business Name): GEORGE J. RUCCO JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E BROAD ST
HAZLETON PA
18201-6835
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5214
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-4000
  • Fax: 570-501-6203
Mailing address:
  • Phone: 914-637-3510
  • Fax: 914-819-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN503256L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: