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General NPI Number Information
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NPI Number | 1639887755
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Entity Type | Organization
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Legal Business Name | EAST COAST GYNECOLOGY PC
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 31 MERRICK AVE. SUITE #230
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City | MERRICK
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State | NY
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Zip | 11566
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Country | US
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Telephone | 516-712-6565
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Fax | 516-217-4049
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Provider Business Mailing Address
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Address Line | 31 MERRICK AVE. SUITE #230
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City | MERRICK
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State | NY
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Zip | 11566
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Country | US
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Telephone | 516-712-6565
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Fax | 516-217-4049
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KERRY RUT
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Credential | D.O.
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Telephone | 516-712-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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