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General NPI Number Information
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NPI Number | 1780987610
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Entity Type | Organization
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Legal Business Name | AR MEDICAL PC
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 6100 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19142-3224
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Country | US
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Telephone | 732-306-1724
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Fax | 267-535-2757
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Provider Business Mailing Address
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Address Line | 1212 VETERANS HWY SUITE A-1 BOX 845
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City | BRISTOL
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State | PA
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Zip | 19007-2512
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Country | US
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Telephone | 732-306-1724
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Fax | 267-535-2757
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PRESIDENT
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Name | ALEXANDER RUSANOV
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Credential | M.D.
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Telephone | 732-306-1724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD436215
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD436215
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License Number State | PA
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