Provider Demographics
NPI:1801031893
Name:NEW YORK MEDICAL DOCTORS, PA
Entity Type:Organization
Organization Name:NEW YORK MEDICAL DOCTORS, PA
Other - Org Name:NEW YORK MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUGGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-340-0923
Mailing Address - Street 1:782 E PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2271
Mailing Address - Country:US
Mailing Address - Phone:772-340-0923
Mailing Address - Fax:772-340-4462
Practice Address - Street 1:782 E PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2271
Practice Address - Country:US
Practice Address - Phone:772-340-0923
Practice Address - Fax:772-340-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00067996261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherCHAMPUS ID