Provider Demographics
NPI:1639887755
Name:EAST COAST GYNECOLOGY PC
Entity Type:Organization
Organization Name:EAST COAST GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-712-6565
Mailing Address - Street 1:31 MERRICK AVE.
Mailing Address - Street 2:SUITE #230
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-712-6565
Mailing Address - Fax:516-217-4049
Practice Address - Street 1:31 MERRICK AVE.
Practice Address - Street 2:SUITE #230
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:516-712-6565
Practice Address - Fax:516-217-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty