MEDICARE: MEREDITH MCNELIS RUIZ MS

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	363AM0700X	Medical Physician Assistant	MA060436	PA

General Provider Information

NPI Number	:	1336638287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH MCNELIS RUIZ MS

Provider Business Mailing Address
First Line	:	261 OLD YORK RD STE 724
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-3725
Country	:	US
Telephone Number	:	215-671-4280
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 ROOSEVELT BLVD, ST 501
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1911
Country	:	US
Telephone Number	:	215-673-5000
Fax Number	:

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

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	07/29/2024

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