Healthcare Provider Details

I. General information

NPI: 1528204161
Provider Name (Legal Business Name): LAURA B RUOF D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2009
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 56TH ST SUITE 610
NEW YORK NY
10022-3607
US

IV. Provider business mailing address

120 E 56TH ST SUITE 610
NEW YORK NY
10022-3607
US

V. Phone/Fax

Practice location:
  • Phone: 212-826-2322
  • Fax: 212-826-1211
Mailing address:
  • Phone: 212-826-2322
  • Fax: 212-826-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number054059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: