Healthcare Provider Details

I. General information

NPI: 1770986044
Provider Name (Legal Business Name): RUTANA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DAVID BRAINERD DR
MONROE NJ
08831-1927
US

IV. Provider business mailing address

108 HOLLAND DR
SOMERSET NJ
08873-4658
US

V. Phone/Fax

Practice location:
  • Phone: 732-521-6663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00237200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number40QB00237200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: