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NPI Code Detail

MEDICARE: DR. RUTH CHADAB CREPET MD

MEDICARE: DR. RUTH CHADAB CREPET MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician181204-1NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3110078649OTHERNYRR MEDICARE PIN
4CC8362OTHERNYRR MEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306810270
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUTH CHADAB CREPET MD
Provider Business Mailing Address
First Line : 1 GUTHRIE SQ
Second Line :
City : SAYRE
State : PA
Zip : 18840-1625
Country : US
Telephone Number : 570-888-5858
Fax Number :
Provider Business Practice Location Address
First Line : 1780 HANSHAW RD
Second Line :
City : ITHACA
State : NY
Zip : 14850-9105
Country : US
Telephone Number : 607-257-5858
Fax Number : 607-257-1718
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 04/02/2021

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