MEDICARE: JAY L RUGOFF DC PLLC

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	111N00000X	Chiropractor	X004546	NY

General Provider Information

NPI Number	:	1750329173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY L RUGOFF DC PLLC

Provider Business Mailing Address
First Line	:	1375 WASHINGTON AVE
Second Line	:	SUITEG102
City	:	ALBANY
State	:	NY
Zip	:	12206-1070
Country	:	US
Telephone Number	:	518-489-2628
Fax Number	:	518-489-6516

Provider Business Practice Location Address
First Line	:	1375 WASHINGTON AVE
Second Line	:	SUITEG102
City	:	ALBANY
State	:	NY
Zip	:	12206-1070
Country	:	US
Telephone Number	:	518-489-2628
Fax Number	:	518-489-6516

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	DR. JAY RUGOFF
Credential	:	D.C.
Telephone Number	:	518-489-2628

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	04/08/2016

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