Healthcare Provider Details

I. General information

NPI: 1427967454
Provider Name (Legal Business Name): RUTH AMOS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22121 JAMAICA AVE FL 2
QUEENS VILLAGE NY
11428-2015
US

IV. Provider business mailing address

11831 220TH ST
CAMBRIA HEIGHTS NY
11411-2008
US

V. Phone/Fax

Practice location:
  • Phone: 718-468-6923
  • Fax:
Mailing address:
  • Phone: 718-926-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number352175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: