Provider Demographics
NPI:1669632535
Name:SUSAN E. RUSKIN, MD,PC
Entity Type:Organization
Organization Name:SUSAN E. RUSKIN, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-647-0496
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-0002
Mailing Address - Country:US
Mailing Address - Phone:781-647-0496
Mailing Address - Fax:
Practice Address - Street 1:11 RIVER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2098
Practice Address - Country:US
Practice Address - Phone:781-647-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA598692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty