Healthcare Provider Details

I. General information

NPI: 1699355859
Provider Name (Legal Business Name): NYC NP IN PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 PRINCE ST APT 205
NEW YORK NY
10012-2936
US

IV. Provider business mailing address

177 PRINCE ST
NEW YORK NY
10012-2946
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOSE MIGUEL RUIZ
Title or Position: OWNER
Credential: NP
Phone: 212-951-1795