Healthcare Provider Details

I. General information

NPI: 1184855116
Provider Name (Legal Business Name): RUBY FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ROME AVE
STATEN ISLAND NY
10304-3149
US

IV. Provider business mailing address

131 ROME AVE
STATEN ISLAND NY
10304-3149
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-5440
  • Fax: 718-989-9282
Mailing address:
  • Phone: 718-876-0248
  • Fax: 718-989-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number238056
License Number StateNY

VIII. Authorized Official

Name: DR. MAUNG TINT WAI
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-439-5440