Provider Demographics
NPI:1083745160
Name:RUHL, VINCENT (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:RUHL
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HART PLACE
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-242-5501
Mailing Address - Fax:631-242-5501
Practice Address - Street 1:7 HART PLACE
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:631-242-5501
Practice Address - Fax:631-242-5501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00923601103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2721009OtherOXFORD HEALTH
V94611Medicare ID - Type Unspecified