Provider Demographics
NPI:1427452267
Name:VEGA-RUSCHER, CHRISTINE (RD, CDN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VEGA-RUSCHER
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDN
Mailing Address - Street 1:29 ROBERTSON DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3018
Mailing Address - Country:US
Mailing Address - Phone:347-245-9507
Mailing Address - Fax:
Practice Address - Street 1:19 TOWER HILL DR
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992
Practice Address - Country:US
Practice Address - Phone:347-245-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008125133N00000X
NY008125-1133V00000X
IL1072916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist