Provider Demographics
NPI:1962020404
Name:RUSCH, VICTORIA ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:RUSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3302
Mailing Address - Country:US
Mailing Address - Phone:315-806-5343
Mailing Address - Fax:
Practice Address - Street 1:10 BURKLE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3259
Practice Address - Country:US
Practice Address - Phone:315-342-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1048388161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist