Healthcare Provider Details

I. General information

NPI: 1750947495
Provider Name (Legal Business Name): JOANNA RUGGIERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA DUNN MD

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 SOUTHWESTERN BLVD STE 704
HAMBURG NY
14075-1870
US

IV. Provider business mailing address

4535 SOUTHWESTERN BLVD STE 704
HAMBURG NY
14075-1870
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number322712
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: