MEDICARE: DR. CECILIA P. RUELOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	133654	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275593543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECILIA P. RUELOS M.D.

Provider Business Mailing Address
First Line	:	381 CHURCH STREET
Second Line	:	SECOND FLOOR
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-8640
Country	:	US
Telephone Number	:	518-306-5292
Fax Number	:	518-306-5292

Provider Business Practice Location Address
First Line	:	381 CHURCH STREET
Second Line	:	SECOND FLOOR
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-8640
Country	:	US
Telephone Number	:	518-306-5292
Fax Number	:	518-306-5292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	09/16/2009

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