Healthcare Provider Details

I. General information

NPI: 1760829550
Provider Name (Legal Business Name): RUBA KATRAJIAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 188TH ST
BRONX NY
10458-5302
US

IV. Provider business mailing address

567 CABOT HILL RD
BRIDGEWATER NJ
08807
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number286797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: