Provider Demographics
NPI:1063228898
Name:RUIZ-HUIDOBRO MAGDITS, NICHOLAS ANDRES
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANDRES
Last Name:RUIZ-HUIDOBRO MAGDITS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:RUIZ-HUIDOBRO
Other - Last Name:MAGDITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463 7TH AVE
Mailing Address - Street 2:FL 18
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:463 7TH AVE
Practice Address - Street 2:FL 18
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7760
Practice Address - Country:US
Practice Address - Phone:212-582-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst