Provider Demographics
NPI:1083892962
Name:RUSK, JOANNA PRICE (NPP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:PRICE
Last Name:RUSK
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:JOANNA
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NPP
Mailing Address - Street 1:2020 CONEY ISLAND AVENUE MIDWOOD ADOLESCENT CLINIC
Mailing Address - Street 2:JEWISH BOARD OF FAMILY AND CHILDREN'S SERVICES(JBFCS)
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-676-4280
Mailing Address - Fax:718-676-4299
Practice Address - Street 1:2020 CONEY ISLAND AVENUE MIDWOOD ADOLESCENT CLINIC
Practice Address - Street 2:JEWISH BOARD OF FAMILY AND CHILDREN'S SERVICES(JBFCS)
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-676-4280
Practice Address - Fax:718-676-4299
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40 400878363LP0808X
NYF400878363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health