Healthcare Provider Details

I. General information

NPI: 1013335439
Provider Name (Legal Business Name): NICOLE CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 10/23/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 EAST 70TH STREET WEILL CORNELL INTERNAL MEDICINE ASSOCIATES
NEW YORK NY
10021
US

IV. Provider business mailing address

520 EAST 70TH STREET, STARR 341 WEILL CORNELL INTERNAL MEDICINE ASSOCIATES
NEW YORK NY
10021-0000
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-9663
  • Fax: 212-746-3609
Mailing address:
  • Phone: 646-962-2065
  • Fax: 212-821-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number288580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: