Provider Demographics
NPI:1366450942
Name:RUGGIERO, SALVATORE LOUIS (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:LOUIS
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE N-10
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-775-1818
Mailing Address - Fax:516-775-0892
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE N-10
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-775-1818
Practice Address - Fax:516-775-0892
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0440121223P0106X, 1223S0112X, 1223X0008X, 1223X0400X, 204E00000X
NY188732174400000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0117134OtherAETNA
NYAS632OtherOXFORD
NY01335919Medicaid
NY5C4817OtherHEALTHNET
NY01559719Medicaid
NYD7I151OtherBC/BS
NYD7I121Medicare ID - Type UnspecifiedMEDICARE
NY01335919Medicaid