Healthcare Provider Details

I. General information

NPI: 1831164680
Provider Name (Legal Business Name): RUBEN OLMEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL FL 12
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

BOX 1149 ONE GUSTAVE LEVY PLACE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 917-595-9920
  • Fax:
Mailing address:
  • Phone: 212-241-0101
  • Fax: 212-426-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number27804
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number203456 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: