Healthcare Provider Details

I. General information

NPI: 1992611412
Provider Name (Legal Business Name): STEPHANIE RUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SUNNYSIDE RD
WEST ORANGE NJ
07052-2032
US

IV. Provider business mailing address

325 FORBUSH ST
BOONTON NJ
07005-2029
US

V. Phone/Fax

Practice location:
  • Phone: 973-302-5309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00297500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: