Provider Demographics
NPI:1962736272
Name:RUIZ, LUCIANO ENRIQUE (OT)
Entity type:Individual
Prefix:
First Name:LUCIANO
Middle Name:ENRIQUE
Last Name:RUIZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WYCKOFF AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-3352
Mailing Address - Country:US
Mailing Address - Phone:718-407-0872
Mailing Address - Fax:
Practice Address - Street 1:1630 E 15TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1147
Practice Address - Country:US
Practice Address - Phone:718-787-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist