Healthcare Provider Details

I. General information

NPI: 1790861417
Provider Name (Legal Business Name): ALEXANDER RUVINSKY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MADISON AVE FRNT 2
NEW YORK NY
10022-1801
US

IV. Provider business mailing address

335 STATE ST APT 2C
BROOKLYN NY
11217-1719
US

V. Phone/Fax

Practice location:
  • Phone: 212-891-2160
  • Fax:
Mailing address:
  • Phone: 718-596-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0209531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: