Provider Demographics
NPI:1679547970
Name:RUIZ, JOHN (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:RUIZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.
Mailing Address - Street 2:ST. MARY'S HOSPITAL AT AMSTERDAM
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7430
Mailing Address - Fax:518-841-7121
Practice Address - Street 1:4988 STATE HIGHWAY 30
Practice Address - Street 2:ST. MARY'S HOSPITAL, MEMORIAL CAMPUS FAM HLTH CNTR
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-841-3770
Practice Address - Fax:518-841-3775
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-09-21
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Provider Licenses
StateLicense IDTaxonomies
NY140126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ754196AUKMedicare ID - Type Unspecified
NJC81477Medicare UPIN