Provider Demographics
NPI:1912291931
Name:RUGG, IAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:RUGG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 91ST ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5839
Mailing Address - Country:US
Mailing Address - Phone:929-276-2593
Mailing Address - Fax:
Practice Address - Street 1:545 73RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2611
Practice Address - Country:US
Practice Address - Phone:929-276-2593
Practice Address - Fax:718-238-1405
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020952103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist