Doctor Name: | MR. ANDREW CRUZ |
NPI Number: | 1356432504 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RPA-C |
License Number: | 010611 |
Business Practice Address: | 14 Marilyn St Manorville, NY - 119493011 |
Business Phone Number: | 5163769334 |
Business Fax Number: | |
Mailing Address: | 14 Marilyn Street, MANORVILLE |
State: | NY |
Postal Code: | 11949 |
Phone Number: | 5163769334 |
Fax Number: | |
NPI Enumeration Date: | 09/27/2006 |
NPI Last Update Date: | 05/26/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 010611 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |