Healthcare Provider Details

I. General information

NPI: 1366450942
Provider Name (Legal Business Name): SALVATORE LOUIS RUGGIERO D.M.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARCUS AVE SUITE N-10
NEW HYDE PARK NY
11042-1011
US

IV. Provider business mailing address

2001 MARCUS AVE SUITE N-10
NEW HYDE PARK NY
11042-1011
US

V. Phone/Fax

Practice location:
  • Phone: 516-775-1818
  • Fax: 516-775-0892
Mailing address:
  • Phone: 516-775-1818
  • Fax: 516-775-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number044012
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number044012
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number044012
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044012
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number188732
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number044012
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number188732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: