Healthcare Provider Details

I. General information

NPI: 1780801258
Provider Name (Legal Business Name): JAMES A RUGGIERO D.MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KINDERKAMACK ROAD
RIVER EDGE NJ
07661
US

IV. Provider business mailing address

110 KINDERKAMACK ROAD
RIVER EDGE NJ
07661
US

V. Phone/Fax

Practice location:
  • Phone: 201-692-0800
  • Fax:
Mailing address:
  • Phone: 201-692-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD108228
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: