Provider Demographics
NPI:1164771952
Name:RUIZ, DENISE H (MS, FNP-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:H
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 FURNACE RD STE 600
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-8974
Mailing Address - Country:US
Mailing Address - Phone:315-791-0050
Mailing Address - Fax:
Practice Address - Street 1:6280 FURNACE RD STE 600
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-8974
Practice Address - Country:US
Practice Address - Phone:315-791-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY337501OtherNY LICENSE
NY05042966Medicaid