Healthcare Provider Details

I. General information

NPI: 1710676697
Provider Name (Legal Business Name): JOSEPH RUGGIERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HWY
WEST ISLIP NY
11795
US

IV. Provider business mailing address

GOOD SAMARITAN HOSPITAL MEDICAL CENTER 1000 MONTAUK HWY
WEST ISLIP NY
11795
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-3420
  • Fax: 631-376-3420
Mailing address:
  • Phone:
  • Fax: 631-376-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: