MEDICARE: MR. GEORGE J. RUCCO JR. CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN503256L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770585549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE J. RUCCO JR. CRNA

Provider Business Mailing Address
First Line	:	10 COMMERCE DR
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-5214
Country	:	US
Telephone Number	:	914-637-3510
Fax Number	:	914-819-0061

Provider Business Practice Location Address
First Line	:	700 E BROAD ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-6835
Country	:	US
Telephone Number	:	570-501-4000
Fax Number	:	570-501-6203

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	06/03/2013

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