Provider Demographics
NPI:1245575190
Name:RUIZ, ESMERALDA G (SE)
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:G
Last Name:RUIZ
Suffix:
Gender:F
Credentials:SE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 W 18TH ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4458
Mailing Address - Country:US
Mailing Address - Phone:917-514-4163
Mailing Address - Fax:
Practice Address - Street 1:352 W 18TH ST APT 4C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4458
Practice Address - Country:US
Practice Address - Phone:917-514-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY611814121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist