Provider Demographics
NPI:1063411064
Name:RUSKIN, CRAIG J (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:RUSKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:RUSKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-331-9595
Mailing Address - Fax:407-331-8484
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-331-9595
Practice Address - Fax:407-331-8484
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63210208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372651700Medicaid
FL372651700Medicaid
FL18216ZMedicare PIN