Healthcare Provider Details

I. General information

NPI: 1730829201
Provider Name (Legal Business Name): RURI KITADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

26901 76TH AVE
NEW HYDE PARK NY
11040-1433
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33678901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: