MEDICARE: PHYLLIS RUGLIO KORMANN LCSW

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	1041C0700X	Clinical Social Worker	44SC00351900	NJ

General Provider Information

NPI Number	:	1558443325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS RUGLIO KORMANN LCSW

Provider Business Mailing Address
First Line	:	700 AIRPORT RD
Second Line	:	P.O. BOX 2036
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5907
Country	:	US
Telephone Number	:	732-367-4700
Fax Number	:	732-364-2253

Provider Business Practice Location Address
First Line	:	1500 ROUTE 88
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-2320
Country	:	US
Telephone Number	:	732-785-1900
Fax Number	:	732-785-9500

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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