Provider Demographics
NPI:1902955701
Name:RUGE, KENNETH CARL (DMIN)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CARL
Last Name:RUGE
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RECTORY ST
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3818
Mailing Address - Country:US
Mailing Address - Phone:914-967-3339
Mailing Address - Fax:
Practice Address - Street 1:2 RECTORY ST
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3818
Practice Address - Country:US
Practice Address - Phone:914-967-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist