Provider Demographics
NPI:1114412004
Name:RUCH, JASON THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:THOMAS
Last Name:RUCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LIEN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6505
Mailing Address - Country:US
Mailing Address - Phone:732-608-3196
Mailing Address - Fax:
Practice Address - Street 1:201 HOOPER AVE STE 4
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7671
Practice Address - Country:US
Practice Address - Phone:732-608-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00592200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002980Medicaid