Provider Demographics
NPI:1073679510
Name:BARUIZ, ETHEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:D
Last Name:BARUIZ
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 1:169 MINNISINK RD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1803
Mailing Address - Country:US
Mailing Address - Phone:973-256-7100
Mailing Address - Fax:973-890-4574
Practice Address - Street 1:169 MINNISINK RD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1803
Practice Address - Country:US
Practice Address - Phone:973-256-7100
Practice Address - Fax:973-890-4574
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA027300002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA02730000OtherLICENSE NUMBER
NJE58970Medicare UPIN