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NPI Code Detail

MEDICARE: RUBY KOLTUN DIENSTAG

MEDICARE: RUBY KOLTUN DIENSTAG
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1811732043
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUBY KOLTUN DIENSTAG
Provider Business Mailing Address
First Line : 7076 N WOLCOTT AVE APT 3
Second Line :
City : CHICAGO
State : IL
Zip : 60626-2382
Country : US
Telephone Number : 718-644-1217
Fax Number :
Provider Business Practice Location Address
First Line : 1507 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4702
Country : US
Telephone Number : 773-569-1468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2024
Last Update Date : 05/05/2026

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Directions to “ RUBY KOLTUN DIENSTAG ” Practice Location

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