Provider Demographics
NPI:1194840488
Name:FERNANDEZ, RUTH ANN (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 W 56TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-8003
Mailing Address - Country:US
Mailing Address - Phone:212-265-9797
Mailing Address - Fax:212-459-3793
Practice Address - Street 1:162 W 56TH ST STE 306
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-265-9797
Practice Address - Fax:212-459-3793
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-006961111NR0400X, 111NS0005X
NYX006961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician