Provider Demographics
NPI:1124199922
Name:NOEL, RUTHVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTHVEN
Middle Name:
Last Name:NOEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4514
Mailing Address - Country:US
Mailing Address - Phone:718-469-3377
Mailing Address - Fax:718-469-3865
Practice Address - Street 1:1416 BEVERLEY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4514
Practice Address - Country:US
Practice Address - Phone:718-469-3377
Practice Address - Fax:718-469-3865
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00949913Medicaid
NY0029132OtherGHI
NY3313507OtherAETNA
NY00949913Medicaid
NY0029132OtherGHI