Basic Information
| Provider Information | |||||||||
| NPI: | 1972628014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUVO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 484 TEMPLE HILL RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125535557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455653700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 558 LARKFIELD RD | ||||||||
| Address2: | |||||||||
| City: | EAST NORTHPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117314204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455653700 | ||||||||
| FaxNumber: | 8455653696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 050882 | CT | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 25MA06164300 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 169290 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0410543 | 05 | NJ | MEDICAID | 273979 | 05 | CT | MEDICAID | 01086800 | 05 | NY | MEDICAID |