Provider Demographics
NPI:1528891744
Name:TAVARES, RUTH (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5319
Mailing Address - Country:US
Mailing Address - Phone:917-579-5766
Mailing Address - Fax:
Practice Address - Street 1:701 SALEM ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5319
Practice Address - Country:US
Practice Address - Phone:917-579-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26NR15822000163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty