Provider Demographics
NPI:1972184323
Name:RUSU, JENICA (NP)
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:
Last Name:RUSU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENI
Other - Middle Name:
Other - Last Name:RUSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:30 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1128
Mailing Address - Country:US
Mailing Address - Phone:917-599-6361
Mailing Address - Fax:
Practice Address - Street 1:14445 87TH AVE
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-3109
Practice Address - Country:US
Practice Address - Phone:718-906-9980
Practice Address - Fax:718-906-9989
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347376363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily