1235119066 NPI number — MS. RUTH G DIAZ MD

Table of content: MS. RUTH G DIAZ MD (NPI 1235119066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235119066 NPI number — MS. RUTH G DIAZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
RUTH
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235119066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 ROUTE 111
Provider Second Line Business Mailing Address:
FL 2
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-224-1819
Provider Business Mailing Address Fax Number:
631-224-1812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 ROUTE 111
Provider Second Line Business Practice Location Address:
FL 2
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-4339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-224-1819
Provider Business Practice Location Address Fax Number:
631-224-1812
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  116667 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2188984 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10438 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OH283P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00847970 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426010368 . This is a "FIDELIS CARE OF NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26047 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 582902 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1309464 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".




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