Provider Demographics
NPI:1366402950
Name:BRUUN, RUTH DOWLING (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:DOWLING
Last Name:BRUUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12 BRIDLE PATH, PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:REMSENBURG
Mailing Address - State:NY
Mailing Address - Zip Code:11960
Mailing Address - Country:US
Mailing Address - Phone:631-325-8298
Mailing Address - Fax:631-369-6045
Practice Address - Street 1:12 BRIDLE PATH
Practice Address - Street 2:
Practice Address - City:REMSENBURG
Practice Address - State:NY
Practice Address - Zip Code:11960
Practice Address - Country:US
Practice Address - Phone:631-325-8298
Practice Address - Fax:631-369-6045
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1054722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00184285Medicaid
NY566151Medicare ID - Type Unspecified
NY00184285Medicaid