Provider Demographics
NPI:1376542704
Name:RUGGIERO, SAMUEL F (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:F
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4527
Mailing Address - Country:US
Mailing Address - Phone:716-896-6262
Mailing Address - Fax:716-897-3338
Practice Address - Street 1:10440 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1627
Practice Address - Country:US
Practice Address - Phone:716-759-6005
Practice Address - Fax:716-897-3338
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN3433213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001061Medicare ID - Type Unspecified
NY0869920001Medicare NSC