Provider Demographics
NPI:1346388980
Name:RUPPENSTEIN, RICHARD GEORGE (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GEORGE
Last Name:RUPPENSTEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 GEORGE CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1316
Mailing Address - Country:US
Mailing Address - Phone:631-473-4755
Mailing Address - Fax:631-928-7609
Practice Address - Street 1:102 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1813
Practice Address - Country:US
Practice Address - Phone:631-473-0611
Practice Address - Fax:631-642-1617
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002015363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical