Healthcare Provider Details

I. General information

NPI: 1568538379
Provider Name (Legal Business Name): ELVIN G RUIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 57TH ST STE 808
NEW YORK NY
10019-2817
US

IV. Provider business mailing address

57 W 57TH ST STE 808
NEW YORK NY
10019-2817
US

V. Phone/Fax

Practice location:
  • Phone: 646-275-0984
  • Fax: 707-736-9228
Mailing address:
  • Phone: 646-275-0984
  • Fax: 707-736-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number143612
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number143612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: