Healthcare Provider Details

I. General information

NPI: 1790626760
Provider Name (Legal Business Name): RUCHI KULSHRESTHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4418 RIDGE RD
WILLIAMSON NY
14589-9306
US

IV. Provider business mailing address

4418 RIDGE RD
WILLIAMSON NY
14589-9306
US

V. Phone/Fax

Practice location:
  • Phone: 315-589-4641
  • Fax: 315-589-9585
Mailing address:
  • Phone: 315-589-4641
  • Fax: 315-589-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340792-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: