1578562971 NPI number — MS. D ANN RUGH PT

Table of content: MS. D ANN RUGH PT (NPI 1578562971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578562971 NPI number — MS. D ANN RUGH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUGH
Provider First Name:
D
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUGH
Provider Other First Name:
ANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578562971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 COLD SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COXSACKIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12051-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-943-6792
Provider Business Mailing Address Fax Number:
518-943-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 COLD SPRING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COXSACKIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12051-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-943-6792
Provider Business Practice Location Address Fax Number:
518-943-0410
Provider Enumeration Date:
07/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  009955-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 438555 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10035007 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q4276 1 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".