MEDICARE: DR. MIKHAIL RUVINSKY 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	051307	NY
2	183500000X	Pharmacist	28RJ03059000	NJ
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1902053804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIKHAIL RUVINSKY MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/09/2010

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