MEDICARE: NORMAN CRUZ NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	520603	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F334419	OTHER	NY	FNP LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	520603-1	OTHER	NY	RN LICENSE
4	2004004483-22	OTHER	NY	ANCC BOARD CERTIFICATION NUMBER

General Provider Information

NPI Number	:	1124071824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMAN CRUZ NP

Provider Business Mailing Address
First Line	:	STONY BROOK UMC
Second Line	:	HSC 18-040
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-7989
Fax Number	:	631-444-6176

Provider Business Practice Location Address
First Line	:	STONY BROOK UMC
Second Line	:	HSC 18-040
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8191
Country	:	US
Telephone Number	:	631-444-7989
Fax Number	:	631-444-6176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/20/2014

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Directions to “ NORMAN CRUZ NP” Practice Location

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