Provider Demographics
NPI:1063679876
Name:RUISI, MARY MAHONEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MAHONEY
Last Name:RUISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, BOX 139
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-3131
Mailing Address - Fax:
Practice Address - Street 1:435 E 70TH ST
Practice Address - Street 2:APARTMENT 11F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5342
Practice Address - Country:US
Practice Address - Phone:212-933-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics