Healthcare Provider Details

I. General information

NPI: 1053758227
Provider Name (Legal Business Name): KARLA RUAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N CORPORATE DR
RIVERDALE NJ
07457-1715
US

IV. Provider business mailing address

6 N CORPORATE DR
RIVERDALE NJ
07457-1715
US

V. Phone/Fax

Practice location:
  • Phone: 862-200-5848
  • Fax: 862-200-5976
Mailing address:
  • Phone: 862-200-5848
  • Fax: 862-200-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number624231
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: