Healthcare Provider Details

I. General information

NPI: 1609855451
Provider Name (Legal Business Name): GEORGE E RUTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 GILBERT ST SUITE 3
CAMBRIDGE NY
12816-2643
US

IV. Provider business mailing address

290 BROWNELL HOLLOW RD
EAGLE BRIDGE NY
12057-2709
US

V. Phone/Fax

Practice location:
  • Phone: 518-677-8575
  • Fax: 518-677-2580
Mailing address:
  • Phone: 518-677-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number145246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: