Healthcare Provider Details

I. General information

NPI: 1003992041
Provider Name (Legal Business Name): RUTHANN PARISE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/28/2008
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: 516-596-1433
Mailing address:
  • Phone: 516-593-8585
  • Fax: 516-596-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: