Provider Demographics
NPI:1598015489
Name:PRYLUCKI-RUGOLO, DIANA KAYE (MS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:KAYE
Last Name:PRYLUCKI-RUGOLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:KAYE
Other - Last Name:PRYLUCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:30 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1313
Mailing Address - Country:US
Mailing Address - Phone:516-263-2349
Mailing Address - Fax:
Practice Address - Street 1:30 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1313
Practice Address - Country:US
Practice Address - Phone:516-263-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1123143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist