Healthcare Provider Details

I. General information

NPI: 1760347447
Provider Name (Legal Business Name): FELIX DE LA CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FORTUNE ROAD
MIDDLETOWN NY
10941
US

IV. Provider business mailing address

17 EDINBURGH RD
MIDDLETOWN NY
10941-1704
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-5556
  • Fax:
Mailing address:
  • Phone: 347-224-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP140030
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: