Healthcare Provider Details

I. General information

NPI: 1376695213
Provider Name (Legal Business Name): GREG RUVOLO L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 57TH ST SUITE 829
NEW YORK NY
10107-0001
US

IV. Provider business mailing address

250 W 57TH ST SUITE 829
NEW YORK NY
10107-0001
US

V. Phone/Fax

Practice location:
  • Phone: 212-459-1447
  • Fax: 212-459-1953
Mailing address:
  • Phone: 212-459-1447
  • Fax: 212-459-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: