MEDICARE: NYC NP IN PSYCHIATRY

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	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1699355859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC NP IN PSYCHIATRY

Provider Business Mailing Address
First Line	:	177 PRINCE ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-2946
Country	:	US
Telephone Number	:	212-844-9259
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 PRINCE ST APT 205
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-2936
Country	:	US
Telephone Number	:	212-844-9259
Fax Number	:	212-844-9259

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE MIGUEL RUIZ
Credential	:	NP
Telephone Number	:	212-951-1795

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	01/12/2023

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