Healthcare Provider Details

I. General information

NPI: 1063207660
Provider Name (Legal Business Name): ARIANA RUGGERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 ASHAROKEN AVE
NORTHPORT NY
11768-1120
US

IV. Provider business mailing address

219 ASHAROKEN AVE
NORTHPORT NY
11768-1120
US

V. Phone/Fax

Practice location:
  • Phone: 631-553-8622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: