Provider Demographics
NPI:1215922661
Name:RUIZ, RESTITUTO S JR (MD)
Entity type:Individual
Prefix:DR
First Name:RESTITUTO
Middle Name:S
Last Name:RUIZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 PASCACK RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4229
Mailing Address - Country:US
Mailing Address - Phone:201-599-0340
Mailing Address - Fax:
Practice Address - Street 1:333 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3200
Practice Address - Country:US
Practice Address - Phone:201-664-4996
Practice Address - Fax:201-599-1351
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07002400207P00000X, 208D00000X, 207R00000X
LAMD.15325R207P00000X
MS18336207P00000X
ARE-6459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05952816Medicaid
AR184064001Medicaid
LA1190845Medicaid
LAI2321OtherBLUE SHIELD
NJ8175900Medicaid
NJ036328Medicare ID - Type Unspecified
LA1190845Medicaid
MS05952816Medicaid
LA4F967DF59Medicare PIN
AR5J496G254Medicare PIN