Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 027049-1 | NY |
NPI | 1073813697 |
---|---|
Provider Name | Mrs. Maria Cecilia Cruz |
First Address | Staten Island, NY 10309-3527 |
Second Address | Staten Island, NY 10309-3527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2010 |
Last Update Date | 05/04/2021 |