Provider Demographics
NPI:1366490195
Name:RUEDA, CARLOS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:RUEDA
Suffix:
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 1:14 EASTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5460
Mailing Address - Country:US
Mailing Address - Phone:917-972-6771
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2040472084P0805X
FLME1408922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01690582Medicaid
NYG21955Medicare UPIN
NY47M231Medicare ID - Type Unspecified
NY47M231Medicare PIN