Healthcare Provider Details

I. General information

NPI: 1043390131
Provider Name (Legal Business Name): MADELINE CRUZ D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HEWITT ST
GARNERVILLE NY
10923-1409
US

IV. Provider business mailing address

3 HEWITT ST
GARNERVILLE NY
10923-1409
US

V. Phone/Fax

Practice location:
  • Phone: 845-786-3830
  • Fax: 845-786-3830
Mailing address:
  • Phone: 845-786-3830
  • Fax: 845-786-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number005347
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: