Provider Demographics
NPI:1235679325
Name:RUIZ, ENRIQUE JR (LMT)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:RUIZ
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3960
Mailing Address - Country:US
Mailing Address - Phone:585-467-7070
Mailing Address - Fax:585-467-7702
Practice Address - Street 1:2164 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3960
Practice Address - Country:US
Practice Address - Phone:585-467-7070
Practice Address - Fax:585-467-7702
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029545225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist