Healthcare Provider Details

I. General information

NPI: 1346050150
Provider Name (Legal Business Name): RUBY MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHARLES EWING BLVD STE 160
EWING NJ
08628-3456
US

IV. Provider business mailing address

1743 SIDEWINDER DR UNIT 114
PARK CITY UT
84060-7322
US

V. Phone/Fax

Practice location:
  • Phone: 307-840-9834
  • Fax: 833-450-0933
Mailing address:
  • Phone: 307-840-9834
  • Fax: 833-450-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PALLABI SANYAL-DEY
Title or Position: PRESIDENT
Credential: MD
Phone: 617-256-3472