Healthcare Provider Details

I. General information

NPI: 1386848265
Provider Name (Legal Business Name): DIEGO RUIZ DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 FRANKLIN AVE
NUTLEY NJ
07110-1253
US

IV. Provider business mailing address

582 FRANKLIN AVE
NUTLEY NJ
07110-1253
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-4601
  • Fax: 973-661-4607
Mailing address:
  • Phone: 973-661-4601
  • Fax: 973-661-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name: DIEGO RUIZ
Title or Position: PRESIDENT
Credential: DC
Phone: 973-661-4601