Provider Demographics
NPI:1417536079
Name:ELETTA, RUTH YEWANDE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:YEWANDE
Last Name:ELETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:YEWANDE
Other - Last Name:SAGBOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:760 BROADWAY
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, ROOM 6B23
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-963-7956
Mailing Address - Fax:718-963-7957
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, ROOM 6B23
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-7956
Practice Address - Fax:718-963-7957
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program