Provider Demographics
NPI:1134159619
Name:RUIZ, RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 MORRIS AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3526
Mailing Address - Country:US
Mailing Address - Phone:908-964-5600
Mailing Address - Fax:908-964-7744
Practice Address - Street 1:1945 MORRIS AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3526
Practice Address - Country:US
Practice Address - Phone:908-964-5600
Practice Address - Fax:908-964-7744
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01015300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065646M7KMedicare ID - Type UnspecifiedRICHARD RUIZ
NJ026090Medicare ID - Type UnspecifiedGROUP ID