Provider Demographics
NPI:1093814550
Name:ELENA RUZZI FARRELL DO PC
Entity Type:Organization
Organization Name:ELENA RUZZI FARRELL DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:RUZZI
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-652-4924
Mailing Address - Street 1:4386 STURBRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3668
Mailing Address - Country:US
Mailing Address - Phone:717-652-4924
Mailing Address - Fax:717-652-1015
Practice Address - Street 1:4386 STURBRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3668
Practice Address - Country:US
Practice Address - Phone:717-652-4924
Practice Address - Fax:717-652-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008191-L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50003172OtherCAPITAL BLUE CROSS
PR50003172OtherCAPITAL BLUE CROSS
PA614458Q2JMedicare ID - Type Unspecified