Healthcare Provider Details

I. General information

NPI: 1093945123
Provider Name (Legal Business Name): EUGENIO CRUZ MATEO MD,MPH&TM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WHITE ST
NEW YORK NY
10013-4497
US

IV. Provider business mailing address

125 WHITE ST
NEW YORK NY
10013-4497
US

V. Phone/Fax

Practice location:
  • Phone: 212-225-1482
  • Fax: 212-225-1489
Mailing address:
  • Phone: 212-225-1482
  • Fax: 212-225-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number161471
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number25MA04562700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: