Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 005347 | NY |
NPI | 1043390131 |
---|---|
Provider Name | Dr. Madeline Cruz |
First Address | Garnerville, NY 10923-1409 |
Second Address | Garnerville, NY 10923-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 26/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01742525 | (05) | NY |
2017970 | UNITED HEALTHCARE (01) | NY |
U65829 | (02) | NY |