Provider Demographics
NPI:1699360008
Name:LIGON, RUBY
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:LIGON
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 1:79 VICARI WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-4041
Mailing Address - Country:US
Mailing Address - Phone:609-857-5275
Mailing Address - Fax:
Practice Address - Street 1:600 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1814
Practice Address - Country:US
Practice Address - Phone:855-968-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01100700363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty