Provider Demographics
NPI:1063478949
Name:RUGOFF, JAY L (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
Last Name:RUGOFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE G102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1070
Mailing Address - Country:US
Mailing Address - Phone:518-229-6794
Mailing Address - Fax:518-489-6516
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE G102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1070
Practice Address - Country:US
Practice Address - Phone:518-229-6794
Practice Address - Fax:518-489-6516
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0425Medicare ID - Type UnspecifiedMEDICARE ID
NYT83170Medicare UPIN