Provider Demographics
NPI:1265559884
Name:RUTH G. DIAZ MD PC
Entity type:Organization
Organization Name:RUTH G. DIAZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-265-4200
Mailing Address - Street 1:994 W JERICHO TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3234
Mailing Address - Country:US
Mailing Address - Phone:631-265-4200
Mailing Address - Fax:
Practice Address - Street 1:994 W JERICHO TPKE STE 201
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3234
Practice Address - Country:US
Practice Address - Phone:631-265-4200
Practice Address - Fax:631-265-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty