Provider Demographics
NPI:1396790382
Name:CECILIA P. RUELOS, M.D.
Entity type:Organization
Organization Name:CECILIA P. RUELOS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-884-0898
Mailing Address - Street 1:61 ROWLAND ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1135
Mailing Address - Country:US
Mailing Address - Phone:518-884-0898
Mailing Address - Fax:518-884-7149
Practice Address - Street 1:61 ROWLAND ST
Practice Address - Street 2:SUITE 208
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1135
Practice Address - Country:US
Practice Address - Phone:518-884-0898
Practice Address - Fax:518-884-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1336542080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00786452Medicaid