Provider Demographics
NPI:1326010216
Name:RUSNAK, JOSEPH G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:RUSNAK
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 1:3040 AMSDELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5835
Mailing Address - Country:US
Mailing Address - Phone:716-649-9000
Mailing Address - Fax:716-649-9005
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220
Practice Address - Country:US
Practice Address - Phone:716-649-9000
Practice Address - Fax:716-649-9005
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1848712085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146158FFOtherPREFERRED CARE
NY00010152406OtherUNIVERA HEALTHCARE
NY000511365004OtherBCBS
NY040426001486OtherFIDELIS OF NEW YORK
NY01248315Medicaid
NY1609206OtherINDEPENDENT HEALTH
NY300080551OtherRR MEDICARE
NY000511365004OtherBCBS
NY00010152406OtherUNIVERA HEALTHCARE
NY12070FMedicare ID - Type Unspecified
NY300080551OtherRR MEDICARE
NY01248315Medicaid