Healthcare Provider Details

I. General information

NPI: 1760476329
Provider Name (Legal Business Name): JONATHAN RUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MURRAY ST
BINGHAMTON NY
13905-3707
US

IV. Provider business mailing address

112 MURRAY ST
BINGHAMTON NY
13905-3707
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-8811
  • Fax: 607-724-5922
Mailing address:
  • Phone: 607-772-8811
  • Fax: 607-724-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number129202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: