Provider Demographics
NPI:1407821804
Name:RUSCH, DAVID GHATAVI (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GHATAVI
Last Name:RUSCH
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:PO BOX 9010
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571-9010
Mailing Address - Country:US
Mailing Address - Phone:516-763-2735
Mailing Address - Fax:516-763-2738
Practice Address - Street 1:19 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5336
Practice Address - Country:US
Practice Address - Phone:516-766-1700
Practice Address - Fax:516-763-2734
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2324612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04120MMedicare ID - Type Unspecified
NYW15902Medicare ID - Type Unspecified
NYI39325Medicare UPIN