Healthcare Provider Details

I. General information

NPI: 1396802807
Provider Name (Legal Business Name): RITA GRUNTLER ROUSSOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 FOX HOLLOW ROAD
RHINEBECK NY
12572
US

IV. Provider business mailing address

7503 NORTH BROADWAY APT 3 EAST
RED HOOK NY
12571
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-5420
  • Fax: 845-876-5362
Mailing address:
  • Phone: 845-876-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number431361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: