Provider Demographics
NPI:1922001734
Name:CHRUSCICKI, CHRISTINE M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:CHRUSCICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 PINEWILD DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4200
Mailing Address - Country:US
Mailing Address - Phone:585-368-6700
Mailing Address - Fax:585-368-6767
Practice Address - Street 1:100 PINEWILD DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4200
Practice Address - Country:US
Practice Address - Phone:585-368-6700
Practice Address - Fax:585-368-6767
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2239972084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027081901OtherUNIVERA
NY1590756OtherINDEPENDENT HEALTH
NY000528078001OtherHEALTH INTEGRATED
NY10696776OtherCAQH
NYRA6225Medicare ID - Type Unspecified
NY00027081901OtherUNIVERA