Provider Demographics
NPI:1891714028
Name:RUH, JENNIFER M (M D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:RUH
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 N BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1853
Mailing Address - Country:US
Mailing Address - Phone:716-508-4040
Mailing Address - Fax:716-508-8038
Practice Address - Street 1:3725 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1853
Practice Address - Country:US
Practice Address - Phone:716-508-4040
Practice Address - Fax:716-508-8038
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1874061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020006901OtherUNIVERA
NY0005230653OtherCOMM BLUE
NY0106734OtherIHA
NY01830331Medicaid
NY0106734OtherIHA
NY116111EMedicare ID - Type Unspecified