Healthcare Provider Details

I. General information

NPI: 1700565918
Provider Name (Legal Business Name): ANN CLAUDIA RUGGLES-MILLER MST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 INDIAN ROCK RD
WILMINGTON NY
12997-7726
US

IV. Provider business mailing address

2075 STATE ROUTE 3
CADYVILLE NY
12918
US

V. Phone/Fax

Practice location:
  • Phone: 518-637-5080
  • Fax:
Mailing address:
  • Phone: 518-561-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: