Provider Demographics
NPI:1124618228
Name:BOCHAT, RUTH (FNP-BC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:BOCHAT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 JARVIN RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1311
Mailing Address - Country:US
Mailing Address - Phone:929-429-6861
Mailing Address - Fax:
Practice Address - Street 1:1 JARVIN RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1311
Practice Address - Country:US
Practice Address - Phone:929-429-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346694-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily