Provider Demographics
NPI:1316192644
Name:RUSTIA, GENALIN ALBANIA (PT)
Entity Type:Individual
Prefix:
First Name:GENALIN
Middle Name:ALBANIA
Last Name:RUSTIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 WATERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5017
Mailing Address - Country:US
Mailing Address - Phone:646-645-3658
Mailing Address - Fax:718-792-3653
Practice Address - Street 1:2348 WATERBURY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5017
Practice Address - Country:US
Practice Address - Phone:646-645-3658
Practice Address - Fax:718-792-3653
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022317Medicaid
NY022317Medicaid
NY022317Medicare PIN
NY022317Medicare Oscar/Certification