Provider Demographics
NPI:1922313022
Name:RUVINOVA, TATYANA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:
Last Name:RUVINOVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4056
Mailing Address - Country:US
Mailing Address - Phone:646-479-8049
Mailing Address - Fax:
Practice Address - Street 1:1 WHITEHALL ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2109
Practice Address - Country:US
Practice Address - Phone:212-509-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist