Provider Demographics
NPI:1235119066
Name:DIAZ, RUTH G (MD)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:G
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:515 ROUTE 111
Mailing Address - Street 2:FL 2
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4339
Mailing Address - Country:US
Mailing Address - Phone:631-224-1819
Mailing Address - Fax:631-224-1812
Practice Address - Street 1:515 ROUTE 111
Practice Address - Street 2:FL 2
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4339
Practice Address - Country:US
Practice Address - Phone:631-224-1819
Practice Address - Fax:631-224-1812
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2020-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY116667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2188984OtherCIGNA
10438OtherVYTRA
OH283POtherHIP
NY00847970Medicaid
040426010368OtherFIDELIS CARE OF NY
26047OtherAETNA
582902OtherEMPIRE BLUE CROSS BLUE SH
1309464OtherFIRST HEALTH
582901Medicare ID - Type Unspecified
OH283POtherHIP