Provider Demographics
NPI:1144524786
Name:DOCTOR'S OFFICE OF WEST CALDWELL LLC
Entity type:Organization
Organization Name:DOCTOR'S OFFICE OF WEST CALDWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-565-3700
Mailing Address - Street 1:484 TEMPLE HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5557
Mailing Address - Country:US
Mailing Address - Phone:845-565-3700
Mailing Address - Fax:845-565-3696
Practice Address - Street 1:556 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7449
Practice Address - Country:US
Practice Address - Phone:973-808-2273
Practice Address - Fax:973-808-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0637246Medicaid