Basic Information
| Provider Information | |||||||||
| NPI: | 1669595963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUIZ | ||||||||
| FirstName: | MARIA CONCEPCION | ||||||||
| MiddleName: | SANCHEZ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 HALF MOON BAY DR | ||||||||
| Address2: | |||||||||
| City: | CROTON ON HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105203101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142710013 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 E 233RD ST | ||||||||
| Address2: | 657 EAST 233RD ST. | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104662604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189209135 | ||||||||
| FaxNumber: | 7189209106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 196212 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01642488 | 05 | NY | MEDICAID |