Provider Demographics
NPI:1609855451
Name:RUTA, GEORGE E (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:E
Last Name:RUTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BROWNELL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12057-2709
Mailing Address - Country:US
Mailing Address - Phone:518-677-3040
Mailing Address - Fax:
Practice Address - Street 1:33 GILBERT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-2643
Practice Address - Country:US
Practice Address - Phone:518-677-8575
Practice Address - Fax:518-677-2580
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1452462080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00765619Medicaid
NYBB2211Medicare ID - Type Unspecified
NYD02358Medicare UPIN