Provider Demographics
NPI:1639391543
Name:RUSCONI, RICHARD A (RN, APN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:RUSCONI
Suffix:
Gender:M
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PATERSON AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-5627
Mailing Address - Country:US
Mailing Address - Phone:973-785-3334
Mailing Address - Fax:973-785-7760
Practice Address - Street 1:275 PATERSON AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-5627
Practice Address - Country:US
Practice Address - Phone:973-785-3334
Practice Address - Fax:973-785-7760
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08865000363L00000X, 363LA2100X, 363LG0600X
NJ26NO08865000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0221791Medicaid
NJ0221791Medicaid
NJ043362XDCMedicare PIN