Individual
CHARLES JAMES RUOTOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5500 MERRICK RD, MASSAPEQUA, NY 11758-6231
(516) 795-3033
Mailing address
5500 MERRICK RD, MASSAPEQUA, NY 11758-6231
(516) 795-3033
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
216303-1
NY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
216303-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02175455
—
NY
Enumeration date
02/27/2006
Last updated
08/19/2009
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