Healthcare Provider Details

I. General information

NPI: 1528446879
Provider Name (Legal Business Name): RUTH ENGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 ROUTE 488 MIDLAKES MIDDLE SCHOOL
CLIFTON SPRINGS NY
14432-9308
US

IV. Provider business mailing address

11635 BAUGHMAN RD
PRATTSBURGH NY
14873-9647
US

V. Phone/Fax

Practice location:
  • Phone: 315-548-6020
  • Fax:
Mailing address:
  • Phone: 607-522-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number286285 - 1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number286285 - 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: