Healthcare Provider Details

I. General information

NPI: 1770657991
Provider Name (Legal Business Name): JOSEPH G RUGGERO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 NEW YORK AVE
MELVILLE NY
11747-1107
US

IV. Provider business mailing address

2470 NEW YORK AVE
MELVILLE NY
11747-1107
US

V. Phone/Fax

Practice location:
  • Phone: 631-424-6674
  • Fax: 631-424-6674
Mailing address:
  • Phone: 631-424-6674
  • Fax: 631-424-6674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: