Healthcare Provider Details

I. General information

NPI: 1679499412
Provider Name (Legal Business Name): RUBY REW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 18TH AVE
BROOKLYN NY
11204-3729
US

IV. Provider business mailing address

516 MYRTLE AVE # 144
BROOKLYN NY
11205-2606
US

V. Phone/Fax

Practice location:
  • Phone: 510-253-6402
  • Fax:
Mailing address:
  • Phone: 510-253-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95453887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN49453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: