Healthcare Provider Details

I. General information

NPI: 1770400079
Provider Name (Legal Business Name): JAILEEN CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DARROW PL
BRONX NY
10475-1802
US

IV. Provider business mailing address

140 DARROW PL APT 7D
BRONX NY
10475-1820
US

V. Phone/Fax

Practice location:
  • Phone: 347-466-8340
  • Fax:
Mailing address:
  • Phone: 347-466-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: