Provider Demographics
NPI:1750329173
Name:JAY L RUGOFF DC PLLC
Entity Type:Organization
Organization Name:JAY L RUGOFF DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-489-2628
Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITEG102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1070
Mailing Address - Country:US
Mailing Address - Phone:518-489-2628
Mailing Address - Fax:518-489-6516
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITEG102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1070
Practice Address - Country:US
Practice Address - Phone:518-489-2628
Practice Address - Fax:518-489-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0425Medicare UPIN