Provider Demographics
NPI:1083712806
Name:RUCKER, STEVE W (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:W
Last Name:RUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 OHIO DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-775-4545
Mailing Address - Fax:516-775-4646
Practice Address - Street 1:4 OHIO DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-775-4545
Practice Address - Fax:516-775-4646
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY164250207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110027840OtherRAILROAD MEDICARE
NY06F011Medicare PIN
NYD91941Medicare UPIN