Healthcare Provider Details

I. General information

NPI: 1073229779
Provider Name (Legal Business Name): PHYLICIA RUGGIERI MS, RD, CDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CUTTERMILL RD
GREAT NECK NY
11021-3259
US

IV. Provider business mailing address

183 LINCOLN AVE
ISLAND PARK NY
11558-1833
US

V. Phone/Fax

Practice location:
  • Phone: 516-751-5736
  • Fax: 516-740-0285
Mailing address:
  • Phone: 516-375-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number009310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: