Provider Demographics
NPI:1508347584
Name:ISRAILOV, RUTY
Entity Type:Individual
Prefix:
First Name:RUTY
Middle Name:
Last Name:ISRAILOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1315
Mailing Address - Country:US
Mailing Address - Phone:516-825-5800
Mailing Address - Fax:
Practice Address - Street 1:214 E SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1315
Practice Address - Country:US
Practice Address - Phone:516-825-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist