Healthcare Provider Details

I. General information

NPI: 1629136361
Provider Name (Legal Business Name): RUTHANN PARISE DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 HEMPSTEAD AVE
MALVERNE NY
11565-1227
US

IV. Provider business mailing address

484 HEMPSTEAD AVE
MALVERNE NY
11565-1227
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-8585
  • Fax:
Mailing address:
  • Phone: 516-593-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN005338
License Number StateNY

VIII. Authorized Official

Name: RUTHANN PARISE
Title or Position: DIRECTOR OFFICER
Credential:
Phone: 516-593-8585