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General NPI Number Information
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NPI Number | 1528118130
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Entity Type | Organization
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Legal Business Name | SEGUNDO RUIZ BELVIS, DIAGNOSTIC & TREATMENT CENTER
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 545 E 142ND ST
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City | BRONX
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State | NY
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Zip | 10454-2110
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Country | US
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Telephone | 718-579-1774
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Fax |
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Provider Business Mailing Address
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Address Line | 545 E 142ND ST
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City | BRONX
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State | NY
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Zip | 10454-2110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR ASSOCIATE EXECUTIVE DIRECTOR
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Name | MS. DOROTHY DONALDSON
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Credential |
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Telephone | 718-579-1774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 043822
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License Number State | NY
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