Healthcare Provider Details

I. General information

NPI: 1821493370
Provider Name (Legal Business Name): ANYELINA MARIA DE LA CRUZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANYELINA MARIA DE LA CRUZ M.D

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 5TH AVE
BAY SHORE NY
11706-4147
US

IV. Provider business mailing address

243 E 149TH ST
BRONX NY
10451-5503
US

V. Phone/Fax

Practice location:
  • Phone: 631-231-5070
  • Fax: 631-435-3288
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number290742-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: