Provider Demographics
NPI:1780798116
Name:RUIZ, JAVIER (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 HUDSON VALLEY AVE
Mailing Address - Street 2:SUITE100
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4747
Mailing Address - Country:US
Mailing Address - Phone:845-565-9800
Mailing Address - Fax:845-565-4801
Practice Address - Street 1:575 HUDSON VALLEY AVE
Practice Address - Street 2:SUITE100
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4747
Practice Address - Country:US
Practice Address - Phone:845-565-9800
Practice Address - Fax:845-565-4801
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201549207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097827Medicaid
NY02097827Medicaid
NY741051Medicare ID - Type Unspecified