MEDICARE: RUTHLYNNE S NACK

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
1	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	590705051	NY

General Provider Information

NPI Number	:	1346191046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTHLYNNE S NACK

Provider Business Mailing Address
First Line	:	4705 156TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-2341
Country	:	US
Telephone Number	:	718-751-5770
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 156TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-2341
Country	:	US
Telephone Number	:	718-751-5770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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Directions to “ RUTHLYNNE S NACK ” Practice Location

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