Healthcare Provider Details

I. General information

NPI: 1578301040
Provider Name (Legal Business Name): JOSEPH THOMAS RUGOLO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2097
US

IV. Provider business mailing address

2896 CHESTER ST
OCEANSIDE NY
11572-1106
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3131
  • Fax:
Mailing address:
  • Phone: 516-512-0964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: