MEDICARE: G RUYACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist	54060	NY

General Provider Information

NPI Number	:	1265626485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	G RUYACK

Provider Business Mailing Address
First Line	:	82 SCOTT DR
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-4830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2094 ALBANY POST ROAD RT 9A
Second Line	:
City	:	MONTROSE
State	:	NY
Zip	:	10548-0100
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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Directions to “ G RUYACK ” Practice Location

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