Provider Demographics
NPI:1124380985
Name:RUIZ, CARLA (MSED)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:NEWCOMBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:1000 SOUTH AVE
Mailing Address - Street 2:LL2
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:LL2
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3409
Practice Address - Country:US
Practice Address - Phone:718-477-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1204370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist