Healthcare Provider Details

I. General information

NPI: 1407970957
Provider Name (Legal Business Name): MICHELLE RUVOLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

IV. Provider business mailing address

230 E RIDGEWOOD AVE
PARAMUS NJ
07652-4142
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-4000
  • Fax:
Mailing address:
  • Phone: 201-967-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA04351600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: