Provider Demographics
NPI:1861270803
Name:TOLBERT, RUBY LEE
Entity type:Individual
Prefix:MISS
First Name:RUBY
Middle Name:LEE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1334
Mailing Address - Country:US
Mailing Address - Phone:914-882-3647
Mailing Address - Fax:
Practice Address - Street 1:102 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1334
Practice Address - Country:US
Practice Address - Phone:914-882-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management