Provider Demographics
NPI:1285813766
Name:KOHAKE, RUTH ANN (RN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:KOHAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 BRONX RIVER RD
Mailing Address - Street 2:5B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1798
Mailing Address - Country:US
Mailing Address - Phone:914-237-5495
Mailing Address - Fax:
Practice Address - Street 1:575 BRONX RIVER RD
Practice Address - Street 2:5B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1798
Practice Address - Country:US
Practice Address - Phone:914-237-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5324351163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01818982Medicaid