Provider Demographics
NPI:1013397660
Name:RUIZ, JOAN M
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 WILLIAMSBRIDGE RD
Mailing Address - Street 2:4C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4857
Mailing Address - Country:US
Mailing Address - Phone:631-662-9557
Mailing Address - Fax:
Practice Address - Street 1:333 WESTCHESTER AVE
Practice Address - Street 2:WEST SUITE 202
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2910
Practice Address - Country:US
Practice Address - Phone:914-328-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator