Healthcare Provider Details

I. General information

NPI: 1174640536
Provider Name (Legal Business Name): MARINA RUZIMOVSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LAKEVILLE RD
NEW HYDE PARK NY
11042-1110
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 516-734-8500
  • Fax: 516-734-8535
Mailing address:
  • Phone: 516-876-5555
  • Fax: 516-876-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number218805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: