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General NPI Number Information
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NPI Number | 1669632535
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Entity Type | Organization
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Legal Business Name | SUSAN E. RUSKIN, MD,PC
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 11 RIVER ST
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City | WELLESLEY
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State | MA
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Zip | 02481-2098
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Country | US
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Telephone | 781-647-0496
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 342
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City | WESTON
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State | MA
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Zip | 02493-0002
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Country | US
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Telephone | 781-647-0496
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN E. RUSKIN
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Credential | M.D.
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Telephone | 781-647-0496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 59869
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License Number State | MA
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