Provider Demographics
NPI:1497911218
Name:RUKEYSER, MIRIAM (SLP)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:RUKEYSER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3817
Mailing Address - Country:US
Mailing Address - Phone:914-698-7012
Mailing Address - Fax:
Practice Address - Street 1:1424 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3817
Practice Address - Country:US
Practice Address - Phone:914-698-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist