MEDICARE: NANA RUSIA RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	963276	NY

General Provider Information

NPI Number	:	1760208763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANA RUSIA RBT

Provider Business Mailing Address
First Line	:	329 W 76TH ST APT 3B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-8062
Country	:	US
Telephone Number	:	646-573-2524
Fax Number	:

Provider Business Practice Location Address
First Line	:	59-45 161ST ST. FRESH MEADOWS
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11365
Country	:	US
Telephone Number	:	718-395-4522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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Directions to “ NANA RUSIA RBT” Practice Location

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