Provider Demographics
NPI:1376528828
Name:RUS, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RUS
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 1:7 LORRAINE CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1633
Mailing Address - Country:US
Mailing Address - Phone:631-813-8216
Mailing Address - Fax:888-939-3964
Practice Address - Street 1:7 LORRAINE CT
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1633
Practice Address - Country:US
Practice Address - Phone:631-813-8216
Practice Address - Fax:888-939-3964
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198185207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC0399OtherMEDICARE
NY02068257Medicaid
NYG64655Medicare UPIN