Healthcare Provider Details

I. General information

NPI: 1386537306
Provider Name (Legal Business Name): ANDREW RUGGIERO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-1424
US

IV. Provider business mailing address

1 VALLEY FORGE RD
OAKLAND NJ
07436-2343
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-3600
  • Fax:
Mailing address:
  • Phone: 551-777-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02338200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: