Healthcare Provider Details

I. General information

NPI: 1962421396
Provider Name (Legal Business Name): MARIE T RUGGLES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SPOONER ST
FLORAL PARK NY
11001-2002
US

IV. Provider business mailing address

185 CYPRESS ST
FLORAL PARK NY
11001-3649
US

V. Phone/Fax

Practice location:
  • Phone: 516-326-1393
  • Fax: 516-326-1393
Mailing address:
  • Phone: 516-326-1393
  • Fax: 516-326-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0038631
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: