Provider Demographics
NPI:1407155724
Name:ROODENBURG, JANE RUTH (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:RUTH
Last Name:ROODENBURG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CASTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2103
Mailing Address - Country:US
Mailing Address - Phone:802-735-7598
Mailing Address - Fax:
Practice Address - Street 1:45 FERRY ST
Practice Address - Street 2:THE SAGE COLLEGES WELLNESS CENTER
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-4115
Practice Address - Country:US
Practice Address - Phone:518-244-2261
Practice Address - Fax:518-244-2262
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3392431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily