Basic Information
| Provider Information | |||||||||
| NPI: | 1851810766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUCCIO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 SAINT MARKS PL APT 3 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112171998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606576996 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1855 RICHMOND AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103143912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187610088 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2017 | ||||||||
| LastUpdateDate: | 09/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 002765 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.