MEDICARE: RUGGIERI MEDICAL, P.C.

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1396932836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUGGIERI MEDICAL, P.C.

Provider Business Mailing Address
First Line	:	420 12TH ST
Second Line	:	#P3R
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5158
Country	:	US
Telephone Number	:	718-336-3655
Fax Number	:	718-336-4122

Provider Business Practice Location Address
First Line	:	2977 AVENUE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3203
Country	:	US
Telephone Number	:	718-336-3655
Fax Number	:	718-336-4122

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EWA RUGGIERI
Credential	:	M.D.
Telephone Number	:	718-336-3655

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	10/10/2007

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