Provider Demographics
NPI:1710074885
Name:NIESVIZKY, RUBEN (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:NIESVIZKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 61ST ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8722
Mailing Address - Country:US
Mailing Address - Phone:646-962-6500
Mailing Address - Fax:212-746-8961
Practice Address - Street 1:425 E 61ST ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8722
Practice Address - Country:US
Practice Address - Phone:646-962-6500
Practice Address - Fax:212-746-8961
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195309207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF76831Medicare UPIN
NY838741Medicare ID - Type Unspecified