MEDICARE: MISS RUBY LEE TOLBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1861270803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RUBY LEE TOLBERT

Provider Business Mailing Address
First Line	:	102 HILLSIDE AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10553-1334
Country	:	US
Telephone Number	:	914-882-3647
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 HILLSIDE AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10553-1334
Country	:	US
Telephone Number	:	914-882-3647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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Directions to “ MISS RUBY LEE TOLBERT ” Practice Location

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