Provider Demographics
NPI:1003878265
Name:RUSKIN-MCCORMICK MDS PA
Entity Type:Organization
Organization Name:RUSKIN-MCCORMICK MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-424-9444
Mailing Address - Street 1:350 NW 84TH AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1817
Mailing Address - Country:US
Mailing Address - Phone:954-424-9444
Mailing Address - Fax:
Practice Address - Street 1:350 NW 84TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-424-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260104400Medicaid
FL00640Medicare ID - Type Unspecified