Provider Demographics
NPI:1043396757
Name:RUIZ, FERDINAND (DPM)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 33RD ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2217
Mailing Address - Country:US
Mailing Address - Phone:212-996-0006
Mailing Address - Fax:
Practice Address - Street 1:354 E 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1501
Practice Address - Country:US
Practice Address - Phone:212-996-0006
Practice Address - Fax:212-996-5562
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005557213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02071281Medicaid
NY02071281Medicaid
NYU81524Medicare UPIN