Provider Demographics
NPI:1366642035
Name:RUSKA, KIM MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARY
Last Name:RUSKA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:MOUNT. KISCO MEDICAL GROUP, PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-302-8334
Practice Address - Street 1:90 S BEDFORD RD
Practice Address - Street 2:MOUNT KISCO MEDICAL GROUP, PC
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3412
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-302-8334
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2016-06-16
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07478000207ZD0900X
NY224197-1207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02761975Medicaid
NYA400014185Medicare PIN