MEDICARE: MARY RUGGIERO MD

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	207L00000X	Anesthesiology Physician	164349	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	:	1619956265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RUGGIERO MD

Provider Business Mailing Address
First Line	:	4459 AMBOY RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3863
Country	:	US
Telephone Number	:	718-948-6177
Fax Number	:	718-948-8189

Provider Business Practice Location Address
First Line	:	355 BARD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1664
Country	:	US
Telephone Number	:	718-818-1234
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	09/03/2010

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Directions to “ MARY RUGGIERO MD” Practice Location

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