Active NPI
Kathleen Marie Rusnak
- Pediatric Dentistry
- Orchard Park, NY
National Provider Identifier
1265061329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 062461
- Practice address
- 3364 Southwestern Blvd
Orchard Park, NY 14127-1524 - Phone
- (716) 332-2444
- NPI assigned
- Apr 2, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 062461 | NY | Primary |
Addresses
Primary practice location
3364 Southwestern Blvd
Orchard Park, NY 14127-1524
Mailing address
13991 Route 78
South Wales, NY 14139-9519
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062461 | NY | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671148800000",
"number": "1265061329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13991 ROUTE 78",
"city": "SOUTH WALES",
"state": "NY",
"postal_code": "141399519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3364 SOUTHWESTERN BLVD",
"city": "ORCHARD PARK",
"state": "NY",
"postal_code": "141271524",
"telephone_number": "716-332-2444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSNAK",
"first_name": "KATHLEEN",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-02",
"last_updated": "2022-12-16",
"certification_date": "2022-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "062461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orchard Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.