Healthcare Provider Details

I. General information

NPI: 1316557572
Provider Name (Legal Business Name): PEDRO JOSE CRUZ GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

2491 BELMONT AVE
BRONX NY
10458-6229
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-9331
  • Fax:
Mailing address:
  • Phone: 857-265-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2222551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: