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: 05/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WEST 72ND ST SUITE 1F
NEW YORK NY
10023
US

IV. Provider business mailing address

310 WEST 72ND ST SUITE 1F
NEW YORK NY
10023
US

V. Phone/Fax

Practice location:
  • Phone: 917-265-8544
  • Fax: 917-338-1905
Mailing address:
  • Phone: 917-265-8544
  • Fax: 917-338-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: