Provider Demographics
NPI:1811587207
Name:RUSAKOWICZ, MICHELLE (MASTERS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RUSAKOWICZ
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DELAFIELD ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1707
Mailing Address - Country:US
Mailing Address - Phone:845-452-4167
Mailing Address - Fax:
Practice Address - Street 1:50 DELAFIELD ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1707
Practice Address - Country:US
Practice Address - Phone:845-452-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist