Provider Demographics
NPI:1407809346
Name:NEUROPSYCHIATRY PC
Entity Type:Organization
Organization Name:NEUROPSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-972-6771
Mailing Address - Street 1:14 EASTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5460
Mailing Address - Country:US
Mailing Address - Phone:914-933-3940
Mailing Address - Fax:914-840-1281
Practice Address - Street 1:25 S REGENT ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3512
Practice Address - Country:US
Practice Address - Phone:914-933-3940
Practice Address - Fax:914-840-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2040472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02188705Medicaid
NY02188705Medicaid
NYW3Z661Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #