Individual provider Active NPI

Ruth Llanos, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1790520344
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
405194 Issued in NY
Practice address
102 Rivers Edge Rd
New York, NY 10035-1163
Phone
(646) 766-4478
NPI assigned
Jun 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 405194 NY Primary

Addresses

Primary practice location

102 Rivers Edge Rd
New York, NY 10035-1163

Mailing address

102 Rivers Edge Rd
New York, NY 10035-1163
Phone (646) 766-4478

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241022000545 NY Order and Referring Only - Nurse Practitioner 1355873860

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
405194NYMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1790520344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 RIVERS EDGE RD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100351163",
            "telephone_number": "646-766-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 RIVERS EDGE RD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100351163",
            "telephone_number": "646-766-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLANOS",
        "first_name": "RUTH",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "405194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.