MEDICARE: EMMANUELLE RUOCCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	25MA10179200	NJ

General Provider Information

NPI Number	:	1316365646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUELLE RUOCCO

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:	844-362-1735
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	155 MORRIS AVE STE 204
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1224
Country	:	US
Telephone Number	:	973-763-5010
Fax Number	:	973-763-8163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	10/13/2022

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Directions to “ EMMANUELLE RUOCCO ” Practice Location

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