Provider Demographics
NPI:1548492192
Name:DENYSYK, RUSLAN E (PA-C)
Entity type:Individual
Prefix:
First Name:RUSLAN
Middle Name:E
Last Name:DENYSYK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MCGREGOR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3730
Mailing Address - Country:US
Mailing Address - Phone:603-669-0413
Mailing Address - Fax:603-663-6350
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3730
Practice Address - Country:US
Practice Address - Phone:603-669-0413
Practice Address - Fax:603-663-6350
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant