Basic Information
| Provider Information | |||||||||
| NPI: | 1841558079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODSHALK RUGGLES | ||||||||
| FirstName: | ASHLEE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GODSHALK | ||||||||
| OtherFirstName: | ASHLEE | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | B.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6560 FANNIN ST STE 1404 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137900600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 CAPITAL WAY STE 356 | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095376000 | ||||||||
| FaxNumber: | 6095376002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA10648800 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD468677 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | R2857 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208800000X | R2333 | NH | N | Allopathic & Osteopathic Physicians | Urology | 208C00000X | MD468677 | PA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 25MA10648800 | NJ | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.