1447220090 NPI number — RUDY V NYDEGGER PHD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447220090 NPI number — RUDY V NYDEGGER PHD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NYDEGGER

Provider First Name:

RUDY

Provider Middle Name:

V

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PHD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1447220090

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/16/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2317 BALLTOWN RD

Provider Second Line Business Mailing Address:

SUITE 203

Provider Business Mailing Address City Name:

SCHENECTADY

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

12309-2339

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

518-377-4398

Provider Business Mailing Address Fax Number:

518-384-3750

Provider First Line Business Practice Location Address:

2317 BALLTOWN RD

Provider Second Line Business Practice Location Address:

SUITE 203

Provider Business Practice Location Address City Name:

SCHENECTADY

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

12309-2339

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

518-377-4398

Provider Business Practice Location Address Fax Number:

518-384-3750

Provider Enumeration Date:

01/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 103T00000X , with the licence number:  005721 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103T00000X , with the licence number: 5721 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 110345 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
• Identifier: 1417879160000 . This is a "APA PARTNERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 41107 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 000471951001 . This is a "BLUE SHIELD/HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1014721 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 141787916 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 3472890000 . This is a "ACS OFFICE WORKERS' COMP" identifier . This identifiers is of the category "OTHER".
• Identifier: S05721-6B . This is a "NYS WORKERS' COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 03537919 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: A124956 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 00588954 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".