Provider Demographics
NPI:1659688877
Name:RUFFIN, JEWEL R
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:R
Last Name:RUFFIN
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 1:870 ROSEDALE AVE
Mailing Address - Street 2:APT 5C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3965
Mailing Address - Country:US
Mailing Address - Phone:646-488-6208
Mailing Address - Fax:
Practice Address - Street 1:870 ROSEDALE AVE
Practice Address - Street 2:APT 5C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3965
Practice Address - Country:US
Practice Address - Phone:646-488-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291869164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse