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General NPI Number Information
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NPI Number | 1306178157
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Entity Type | Organization
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Legal Business Name | LOUIS S RUVOLO M D LLC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 1000 SALEM RD STE A
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City | WILLINGBORO
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State | NJ
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Zip | 08046-2852
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Country | US
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Telephone | 609-877-1737
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Fax | 609-877-1589
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Provider Business Mailing Address
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Address Line | 1000 SALEM RD STE A
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City | WILLINGBORO
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State | NJ
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Zip | 08046-2852
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Country | US
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Telephone | 609-877-1737
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Fax | 609-877-1589
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOUIS RUVOLO
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Credential | M.D.
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Telephone | 609-877-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA02679600
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License Number State | NJ
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