Healthcare Provider Details

I. General information

NPI: 1629769039
Provider Name (Legal Business Name): LUCILLE RUGGIERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 AMBOY RD
STATEN ISLAND NY
10312-3820
US

IV. Provider business mailing address

279 MILTON AVE
STATEN ISLAND NY
10306-5613
US

V. Phone/Fax

Practice location:
  • Phone: 718-227-3049
  • Fax: 718-227-3056
Mailing address:
  • Phone: 917-807-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: