Provider Demographics
NPI:1962421396
Name:RUGGLES, MARIE T (RD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:T
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3649
Mailing Address - Country:US
Mailing Address - Phone:516-326-1393
Mailing Address - Fax:516-326-1393
Practice Address - Street 1:2 SPOONER ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2002
Practice Address - Country:US
Practice Address - Phone:516-326-1393
Practice Address - Fax:516-326-1393
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered