Provider Demographics
NPI:1093784050
Name:REYES, RUBY CARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:CARINA
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUBY CARINA
Other - Middle Name:E
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1740 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2847
Mailing Address - Country:US
Mailing Address - Phone:732-906-1717
Mailing Address - Fax:732-906-1781
Practice Address - Street 1:1740 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2847
Practice Address - Country:US
Practice Address - Phone:732-906-1717
Practice Address - Fax:732-906-1781
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05279600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ558000Medicaid
NJ558000Medicaid
NJE54241Medicare UPIN