1265717425 NPI number — JOY MICHELLE RUEDA PT

Table of content: JOY MICHELLE RUEDA PT (NPI 1265717425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265717425 NPI number — JOY MICHELLE RUEDA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUEDA
Provider First Name:
JOY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1265717425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
469 FASHION AVE
Provider Second Line Business Mailing Address:
SUITE 327-328
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10018-7605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-359-9592
Provider Business Mailing Address Fax Number:
718-775-3419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3044 CONEY ISLAND AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-5660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-359-9592
Provider Business Practice Location Address Fax Number:
718-775-3419
Provider Enumeration Date:
10/19/2011

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: 225100000X , with the licence number:  031775 , 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)