Provider Demographics
NPI:1780987610
Name:AR MEDICAL PC
Entity type:Organization
Organization Name:AR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-306-1724
Mailing Address - Street 1:1212 VETERANS HWY
Mailing Address - Street 2:SUITE A-1 BOX 845
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2512
Mailing Address - Country:US
Mailing Address - Phone:732-306-1724
Mailing Address - Fax:267-535-2757
Practice Address - Street 1:6100 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-3224
Practice Address - Country:US
Practice Address - Phone:732-306-1724
Practice Address - Fax:267-535-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436215207L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty