Healthcare Provider Details

I. General information

NPI: 1982564316
Provider Name (Legal Business Name): ABIGAIL DE LA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

295 N 3RD AVE
BAY SHORE NY
11706-4109
US

V. Phone/Fax

Practice location:
  • Phone: 718-847-9233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN06620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: