Healthcare Provider Details

I. General information

NPI: 1265733455
Provider Name (Legal Business Name): JOSE RUIZ PMHNP,RN, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 THOMPSON ST APT-25
NEW YORK NY
10012-5308
US

IV. Provider business mailing address

132 THOMPSON ST APT-25
NEW YORK NY
10012-5308
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-9259
  • Fax:
Mailing address:
  • Phone: 212-844-9259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11089101
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22-542744
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400966-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: