Provider Demographics
NPI:1275593543
Name:RUELOS, CECILIA P (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:P
Last Name:RUELOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 CHURCH STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8640
Mailing Address - Country:US
Mailing Address - Phone:518-306-5292
Mailing Address - Fax:518-306-5292
Practice Address - Street 1:381 CHURCH STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8640
Practice Address - Country:US
Practice Address - Phone:518-306-5292
Practice Address - Fax:518-306-5292
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1336542080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00786452Medicaid
NYBA0713Medicare PIN
NYC66682Medicare UPIN
NY00786452Medicaid