Healthcare Provider Details

I. General information

NPI: 1134798929
Provider Name (Legal Business Name): LORENA RUVINOVA M.S.CCC-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 OAK KNOLL DR
MANALAPAN NJ
07726-3862
US

IV. Provider business mailing address

343 OAK KNOLL DR
MANALAPAN NJ
07726-3862
US

V. Phone/Fax

Practice location:
  • Phone: 347-530-4416
  • Fax:
Mailing address:
  • Phone: 347-530-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01164500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: