Provider Demographics
NPI:1902249147
Name:RUANE, JENNIFER CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:RUANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 S BROAD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3831
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:
Practice Address - Street 1:157 S BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3831
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2808372084P0800X, 390200000X
PAMD4616142084P0800X, 390200000X
PAMT210647390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI20150812007301OtherMEDICARE ENROLLMENT