Provider Demographics
NPI:1447660352
Name:HAI, RUTH
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:HAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1624
Mailing Address - Country:US
Mailing Address - Phone:845-255-3046
Mailing Address - Fax:845-255-0236
Practice Address - Street 1:300 CADMAN PLZ W FL 17
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3229
Practice Address - Country:US
Practice Address - Phone:718-822-1818
Practice Address - Fax:845-633-5777
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04953077Medicaid