Provider Demographics
NPI:1629330329
Name:RUTLEDGE, REGINA M (MS, ED)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:M
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BOWLES AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2801
Mailing Address - Country:US
Mailing Address - Phone:718-448-3087
Mailing Address - Fax:718-448-3087
Practice Address - Street 1:77 BOWLES AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2801
Practice Address - Country:US
Practice Address - Phone:718-448-3087
Practice Address - Fax:718-448-3087
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist