MEDICARE: MIKHAIL RUVINSKY DDS, PC

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	051307	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487969937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKHAIL RUVINSKY DDS, PC

Provider Business Mailing Address
First Line	:	2973 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3201
Country	:	US
Telephone Number	:	718-332-0300
Fax Number	:	718-332-0302

Provider Business Practice Location Address
First Line	:	2973 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3201
Country	:	US
Telephone Number	:	718-332-0300
Fax Number	:	718-332-0302

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MIKHAIL RUVINSKY
Credential	:	MD, DDS, RPH
Telephone Number	:	718-332-0300

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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