Provider Demographics
NPI:1346951001
Name:RUECKHEIM, LYDIA (RD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:RUECKHEIM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 STATE ROUTE 295
Mailing Address - Street 2:
Mailing Address - City:EAST CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12060-3512
Mailing Address - Country:US
Mailing Address - Phone:518-965-4927
Mailing Address - Fax:
Practice Address - Street 1:264 2ND ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4866
Practice Address - Country:US
Practice Address - Phone:413-822-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5538-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered