Healthcare Provider Details

I. General information

NPI: 1891307658
Provider Name (Legal Business Name): JESSICA RUGGIERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ROSE ST
HASTINGS ON HUDSON NY
10706-3410
US

IV. Provider business mailing address

59 ROSE ST
HASTINGS ON HUDSON NY
10706-3410
US

V. Phone/Fax

Practice location:
  • Phone: 914-374-1304
  • Fax:
Mailing address:
  • Phone: 914-374-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number506092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: