Provider Demographics
NPI:1447313978
Name:RUOTOLO, RACHEL ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANNE
Last Name:RUOTOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 FRANKLIN AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2913
Mailing Address - Country:US
Mailing Address - Phone:516-742-3404
Mailing Address - Fax:516-629-3895
Practice Address - Street 1:999 FRANKLIN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2913
Practice Address - Country:US
Practice Address - Phone:516-742-3404
Practice Address - Fax:516-629-3895
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02915011Medicaid
NYA400010640Medicare PIN