1245561661 NPI number — DIABETIC FOOTWEAR SOLUTUIONS LLC

Table of content: DR. HEIDY NYDIA RUIZ PHARMD (NPI 1598524118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245561661 NPI number — DIABETIC FOOTWEAR SOLUTUIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETIC FOOTWEAR SOLUTUIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1245561661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1424 E JONQUIL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60004-3558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-255-5306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CRYSTAL LAKE PLZ
Provider Second Line Business Practice Location Address:
SUITE AW
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014-7966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-444-7239
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
VAN DIGGELEN
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
815-444-7239

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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