Basic Information
| Provider Information | |||||||||
| NPI: | 1558465138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | EDISON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 E SAINT MARKS PL | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115804440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638533 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 166 E SAINT MARKS PL | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115804440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638533 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 010427 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.