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NPI Code Detail

MEDICARE: CHARLENE CRUZ-ROBERTSON PA

MEDICARE: CHARLENE CRUZ-ROBERTSON PA
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
1363A00000XPhysician Assistant003807NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1003807OTHERNYLICENSE#

General Provider Information

NPI Number : 1629041652
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLENE CRUZ-ROBERTSON PA
Provider Business Mailing Address
First Line : 85 W BURNSIDE AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-4015
Country : US
Telephone Number : 718-716-4400
Fax Number : 718-228-7471
Provider Business Practice Location Address
First Line : 85 W BURNSIDE AVE
Second Line :
City : BRONX
State : NY
Zip : 10453-4015
Country : US
Telephone Number : 718-716-4400
Fax Number : 718-228-7471
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 09/07/2010

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Directions to “ CHARLENE CRUZ-ROBERTSON PA” Practice Location

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