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General NPI Number Information
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NPI Number | 1972453132
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Entity Type | Individual
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Provider Name | JACOB ELIJAH RUIZ PTA
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Gender | Male
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 1910 SOUTH RD
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-6053
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Country | US
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Telephone | 845-454-8377
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | STAATSBURG
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State | NY
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Zip | 12580-0008
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Country | US
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Telephone | 629-246-7152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 014805
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License Number State | NY
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