MEDICARE: DR. KRISTINA THERESIA RUFF D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	N006699	NY

General Provider Information

NPI Number	:	1811287436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA THERESIA RUFF D.P.M.

Provider Business Mailing Address
First Line	:	7844 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2966
Country	:	US
Telephone Number	:	718-326-4789
Fax Number	:	718-326-0828

Provider Business Practice Location Address
First Line	:	7844 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2966
Country	:	US
Telephone Number	:	718-326-4789
Fax Number	:	718-326-0828

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

Provider Enumeration Date	:	04/16/2011
Last Update Date	:	06/26/2015

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