Healthcare Provider Details

I. General information

NPI: 1922161132
Provider Name (Legal Business Name): JEANNE RUGGIERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE PERRO RN

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

IV. Provider business mailing address

1953 GRENVILLE RD
SCOTCH PLAINS NJ
07076-2907
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-9272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NC06518600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: