Provider Demographics
NPI:1164465803
Name:BADLER, RUTH L (DO)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
Last Name:BADLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:L
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 E SUNRISE HIGHWAY
Mailing Address - Street 2:208
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-225-7200
Mailing Address - Fax:631-930-9451
Practice Address - Street 1:150 E SUNRISE HIGHWAY
Practice Address - Street 2:208
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-225-7200
Practice Address - Fax:631-930-9451
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2201522085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2458262Medicaid
NYI07128Medicare UPIN
NEP00158453Medicare PIN
NY2458262Medicaid
NY665S41Medicare PIN