Healthcare Provider Details

I. General information

NPI: 1265626485
Provider Name (Legal Business Name): G RUYACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST ROAD RT 9A
MONTROSE NY
10548-0100
US

IV. Provider business mailing address

82 SCOTT DR
WAPPINGERS FALLS NY
12590-4830
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number54060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: