Healthcare Provider Details

I. General information

NPI: 1790602530
Provider Name (Legal Business Name): KYLE ANN RUCKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 VILLAGE CENTER DR UNIT 4-B
FREEHOLD NJ
07728-2510
US

IV. Provider business mailing address

138 VILLAGE CENTER DR UNIT 4-B
FREEHOLD NJ
07728-2510
US

V. Phone/Fax

Practice location:
  • Phone: 732-683-1140
  • Fax:
Mailing address:
  • Phone: 732-683-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00140800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: