Provider Demographics
NPI:1992544795
Name:RUVINOVA, DIANA (MSED)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RUVINOVA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5034
Mailing Address - Country:US
Mailing Address - Phone:646-617-6828
Mailing Address - Fax:
Practice Address - Street 1:2334 E 28TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5034
Practice Address - Country:US
Practice Address - Phone:646-617-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist