Provider Demographics
NPI:1265535751
Name:BRUSCHINI, PAUL D (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:BRUSCHINI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CARTER STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:899 MAIN STREET
Practice Address - Street 2:WILLIAM E MOSHER HEALTH CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-878-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159881FTOtherPREFERRED CARE
NY050301000048OtherFIDELIS
NY11514590OtherCAQH
NY000625563005OtherBCBS
NY9390241OtherIHA
NYP00343647OtherMEDICARE RAILROAD
NY00011283007OtherUNIVERA
S80394Medicare UPIN
NY050301000048OtherFIDELIS