MEDICARE: BRUCE RONALD RISCHERT PA

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	363A00000X	Physician Assistant	010994	NY

General Provider Information

NPI Number	:	1952416448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE RONALD RISCHERT PA

Provider Business Mailing Address
First Line	:	205 KENWOOD AVE
Second Line	:	UNITB
City	:	DELMAR
State	:	NY
Zip	:	12054-2231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 SEWARD ST
Second Line	:	SUITE 3
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1143
Country	:	US
Telephone Number	:	518-581-2860
Fax Number	:	518-581-7358

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	10/29/2007

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