Provider Demographics
NPI:1306178157
Name:LOUIS S RUVOLO M D LLC
Entity Type:Organization
Organization Name:LOUIS S RUVOLO M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-877-1737
Mailing Address - Street 1:1000 SALEM RD STE A
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2852
Mailing Address - Country:US
Mailing Address - Phone:609-877-1737
Mailing Address - Fax:609-877-1589
Practice Address - Street 1:1000 SALEM RD STE A
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2852
Practice Address - Country:US
Practice Address - Phone:609-877-1737
Practice Address - Fax:609-877-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02679600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1316800Medicaid
NJ1316800Medicaid
NJ1566755Medicare PIN