Provider Demographics
NPI:1184855116
Name:RUBY FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:RUBY FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUNG
Authorized Official - Middle Name:TINT
Authorized Official - Last Name:WAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-439-5440
Mailing Address - Street 1:131 ROME AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3149
Mailing Address - Country:US
Mailing Address - Phone:718-876-0248
Mailing Address - Fax:718-989-9282
Practice Address - Street 1:131 ROME AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3149
Practice Address - Country:US
Practice Address - Phone:718-439-5440
Practice Address - Fax:718-989-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238056261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care