Healthcare Provider Details

I. General information

NPI: 1972839546
Provider Name (Legal Business Name): JEAN RUVEL MA, RD, CDE, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD COUNTRY RD SUITE 202
MINEOLA NY
11501-4198
US

IV. Provider business mailing address

300 OLD COUNTRY RD SUITE 202
MINEOLA NY
11501-4198
US

V. Phone/Fax

Practice location:
  • Phone: 516-747-4616
  • Fax: 516-747-4756
Mailing address:
  • Phone: 516-747-4616
  • Fax: 516-747-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: