Healthcare Provider Details

I. General information

NPI: 1780403956
Provider Name (Legal Business Name): TANYA ELIZABETH CARDOZA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 PLANDOME RD
MANHASSET NY
11030-1947
US

IV. Provider business mailing address

69 WALNUT AVE E
FARMINGDALE NY
11735-3845
US

V. Phone/Fax

Practice location:
  • Phone: 347-938-6546
  • Fax:
Mailing address:
  • Phone: 347-938-6546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: