Provider Demographics
NPI:1245192632
Name:CARLOS RUEDA
Entity type:Organization
Organization Name:CARLOS RUEDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD MBA
Authorized Official - Phone:917-972-6771
Mailing Address - Street 1:25 S REGENT ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3512
Mailing Address - Country:US
Mailing Address - Phone:917-972-6771
Mailing Address - Fax:914-840-1281
Practice Address - Street 1:25 S REGENT ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-3512
Practice Address - Country:US
Practice Address - Phone:917-972-6771
Practice Address - Fax:914-840-1281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLOS RUEDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty