Healthcare Provider Details

I. General information

NPI: 1861873945
Provider Name (Legal Business Name): HALEE ANN RUGGIERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 BROADHOLLOW RD STE 202
MELVILLE NY
11747-3668
US

IV. Provider business mailing address

19 SHADY TREE LN
PORT JEFFERSON NY
11777-1923
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-7780
  • Fax:
Mailing address:
  • Phone: 631-742-6763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: