Provider Demographics
NPI:1518702471
Name:RUNGE, WILLIAM EDGAR (MA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDGAR
Last Name:RUNGE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NOBLE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6339
Mailing Address - Country:US
Mailing Address - Phone:703-201-9341
Mailing Address - Fax:
Practice Address - Street 1:45 RIVINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1304
Practice Address - Country:US
Practice Address - Phone:703-201-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program