Healthcare Provider Details

I. General information

NPI: 1023471505
Provider Name (Legal Business Name): SARAH RUITENBERG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CEDAR CREST DR
POMPTON PLAINS NJ
07444-2100
US

IV. Provider business mailing address

19 BONNIEVIEW TERR.
RAMSEY NJ
07446
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-3672
  • Fax:
Mailing address:
  • Phone: 973-831-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number40QA00388000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: