Healthcare Provider Details

I. General information

NPI: 1952233942
Provider Name (Legal Business Name): PHILIP THOMAS RODGERS MACRUARI MA, MED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 S SCHODACK RD
CASTLETON ON HUDSON NY
12033-9644
US

IV. Provider business mailing address

225 MAPLE ST APT 3
GLENS FALLS NY
12801-3759
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-7103
  • Fax: 518-477-7167
Mailing address:
  • Phone: 518-477-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1007394
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: