Healthcare Provider Details

I. General information

NPI: 1013565720
Provider Name (Legal Business Name): AMANDA RUVINSKY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 BRIGHTON BEACH AVE
BROOKLYN NY
11235-6413
US

IV. Provider business mailing address

2883 W 12TH ST APT 19G
BROOKLYN NY
11224-3008
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-3103
  • Fax:
Mailing address:
  • Phone: 347-854-7178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number065868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: