Provider Demographics
NPI:1497798334
Name:RUIZ, JOSE R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:RUIZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HIGH ST N
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1922
Mailing Address - Country:US
Mailing Address - Phone:856-825-9009
Mailing Address - Fax:856-825-4766
Practice Address - Street 1:1600 HIGH ST N
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1922
Practice Address - Country:US
Practice Address - Phone:856-825-9009
Practice Address - Fax:856-825-4766
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00234800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ784404OtherINDEPENDENCE BCBS
NJ7000201Medicaid
NJ784404AATMedicare PIN
NJ784404OtherINDEPENDENCE BCBS
NJ99000514Medicare PIN