Provider Demographics
NPI:1487969937
Name:MIKHAIL RUVINSKY DDS, PC
Entity type:Organization
Organization Name:MIKHAIL RUVINSKY DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS, RPH
Authorized Official - Phone:718-332-0300
Mailing Address - Street 1:2973 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3201
Mailing Address - Country:US
Mailing Address - Phone:718-332-0300
Mailing Address - Fax:718-332-0302
Practice Address - Street 1:2973 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3201
Practice Address - Country:US
Practice Address - Phone:718-332-0300
Practice Address - Fax:718-332-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051307261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03216671Medicaid