Provider Demographics
NPI:1609879410
Name:CHRUSCICKI, JOSEPH E (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:CHRUSCICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SULLYS TRL
Mailing Address - Street 2:STE 5B
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4563
Mailing Address - Country:US
Mailing Address - Phone:585-368-6550
Mailing Address - Fax:585-368-6540
Practice Address - Street 1:141 SULLYS TRL
Practice Address - Street 2:STE 5B
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4563
Practice Address - Country:US
Practice Address - Phone:585-368-6550
Practice Address - Fax:585-368-6540
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2155762084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10989059OtherCAQH
NY00027056901OtherUNIVERA
NY1512813OtherINDEPENDENT HEALTH
NY000528054001OtherHEALTH INTEGRATED
NY000528054001OtherHEALTH INTEGRATED
NY1512813OtherINDEPENDENT HEALTH