Provider Demographics
NPI:1447220090
Name:NYDEGGER, RUDY V (PHD)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:V
Last Name:NYDEGGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 BALLTOWN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2339
Mailing Address - Country:US
Mailing Address - Phone:518-377-4398
Mailing Address - Fax:518-384-3750
Practice Address - Street 1:2317 BALLTOWN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-2339
Practice Address - Country:US
Practice Address - Phone:518-377-4398
Practice Address - Fax:518-384-3750
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005721103T00000X
NY5721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110345OtherMANAGED HEALTH NETWORK
NY1417879160000OtherAPA PARTNERS
NY41107OtherMVP
NY000471951001OtherBLUE SHIELD/HEALTHNOW
1014721OtherCIGNA BEHAVIORAL HEALTH
141787916OtherUNITED HEALTHCARE
3472890000OtherACS OFFICE WORKERS' COMP
NYS05721-6BOtherNYS WORKERS' COMP
NY03537919Medicaid
NYA124956OtherCDPHP
NY00588954Medicaid
NY1417879160000OtherAPA PARTNERS
NYJ100090663Medicare UPIN
NY38125BMedicare ID - Type Unspecified