Healthcare Provider Details

I. General information

NPI: 1386473627
Provider Name (Legal Business Name): JONATHAN W RUOCCO MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVE STE 400
BUFFALO NY
14225-4985
US

IV. Provider business mailing address

5195 MAIN ST APT 6E
WILLIAMSVILLE NY
14221-5385
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-6700
  • Fax:
Mailing address:
  • Phone: 973-931-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: