Provider Demographics
NPI:1568538379
Name:RUIZ, ELVIN G (MD)
Entity Type:Individual
Prefix:
First Name:ELVIN
Middle Name:G
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:310 WEST 72ND ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:917-265-8544
Mailing Address - Fax:917-338-1905
Practice Address - Street 1:310 WEST 72ND ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:917-265-8544
Practice Address - Fax:917-338-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2011-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1436122084P0800X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
57A212Medicare ID - Type Unspecified