=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629585344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUY ARANDA PSY.D., J.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2018
-----------------------------------------------------
Last Update Date | 01/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6801 43RD AVE
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-5154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-457-3715
-----------------------------------------------------
Fax | 718-457-1100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6801 43RD AVE
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-5154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-457-3715
-----------------------------------------------------
Fax | 718-457-1100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0200X
-----------------------------------------------------
Taxonomy Name | Forensic Psychologist
-----------------------------------------------------
License Number | 007521
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------