MEDICARE: MICHAEL WILLIAM RUCCIO AU.D.

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	231H00000X	Audiologist	002765	NY

General Provider Information

NPI Number	:	1851810766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILLIAM RUCCIO AU.D.

Provider Business Mailing Address
First Line	:	26 SAINT MARKS PL APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1998
Country	:	US
Telephone Number	:	860-657-6996
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 RICHMOND AVE STE 101
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3912
Country	:	US
Telephone Number	:	718-761-0088
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	09/12/2017

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