Provider Demographics
NPI:1669492245
Name:RUSK, GARY H (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:H
Last Name:RUSK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1440 YORK AVE
Mailing Address - Street 2:SUITE P-7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-734-1489
Mailing Address - Fax:212-734-7811
Practice Address - Street 1:1440 YORK AVE
Practice Address - Street 2:SUITE P-7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2577
Practice Address - Country:US
Practice Address - Phone:212-734-1489
Practice Address - Fax:212-734-7811
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1066332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC07748Medicare UPIN
NY280391Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER