Healthcare Provider Details

I. General information

NPI: 1518083229
Provider Name (Legal Business Name): CECILLE MARIA RUOCCO R.N., B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1707
US

IV. Provider business mailing address

9 VAN BRUNT ST
STATEN ISLAND NY
10312-3725
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-6006
  • Fax: 718-876-8116
Mailing address:
  • Phone: 718-948-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number3985118-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: