Healthcare Provider Details

I. General information

NPI: 1689568305
Provider Name (Legal Business Name): DANIEL JOSEPH RUGGIERO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

IV. Provider business mailing address

1723 FRANCIS ST UNIT 3C
PHILADELPHIA PA
19130-2447
US

V. Phone/Fax

Practice location:
  • Phone: 800-836-7536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007554
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: