Basic Information
| Provider Information | |||||||||
| NPI: | 1447660352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAI | ||||||||
| FirstName: | RUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 279 MAIN ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | NEW PALTZ | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125611624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452553046 | ||||||||
| FaxNumber: | 8452550236 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 CADMAN PLZ W FL 17 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112013229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188221818 | ||||||||
| FaxNumber: | 8456335777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 291041 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04953077 | 05 | NY | MEDICAID |