Provider Demographics
NPI:1003221193
Name:RUHL, KIRSTEN A (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:A
Last Name:RUHL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 MALTESE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2115
Mailing Address - Country:US
Mailing Address - Phone:845-342-4774
Mailing Address - Fax:845-343-8741
Practice Address - Street 1:249 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2115
Practice Address - Country:US
Practice Address - Phone:845-342-4774
Practice Address - Fax:845-343-8741
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017609363A00000X
NJ25MP00348900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017609OtherNYS LICENSE