Provider Demographics
NPI:1003982836
Name:CHRUSCICKI, ROBERT KARL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KARL
Last Name:CHRUSCICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4620
Mailing Address - Country:US
Mailing Address - Phone:315-724-7744
Mailing Address - Fax:
Practice Address - Street 1:288 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4620
Practice Address - Country:US
Practice Address - Phone:315-724-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0993291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00569920Medicaid
32007BMedicare ID - Type Unspecified
B79514Medicare UPIN