Provider Demographics
NPI:1699877845
Name:RUIZ, ANDREA M (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PALISADE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1108
Mailing Address - Country:US
Mailing Address - Phone:201-795-2452
Mailing Address - Fax:201-795-2405
Practice Address - Street 1:142 PALISADE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1108
Practice Address - Country:US
Practice Address - Phone:201-795-2452
Practice Address - Fax:201-795-2405
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA30020207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3016102Medicaid
NJ3016102Medicaid
NJ450209Medicare ID - Type Unspecified