Healthcare Provider Details

I. General information

NPI: 1881558633
Provider Name (Legal Business Name): KATIE RANURO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 ANDERSON AVE
CLIFFSIDE PARK NJ
07010-1721
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5012
US

V. Phone/Fax

Practice location:
  • Phone: 201-941-8667
  • Fax: 201-941-3353
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02390200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: