Provider Demographics
NPI:1952997934
Name:RUIZ, JOHN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E 62ND ST APT 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8244
Mailing Address - Country:US
Mailing Address - Phone:347-458-0647
Mailing Address - Fax:
Practice Address - Street 1:4008 59TH ST APT 3F
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4855
Practice Address - Country:US
Practice Address - Phone:347-458-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024911225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist