Healthcare Provider Details

I. General information

NPI: 1861131708
Provider Name (Legal Business Name): KATHLEEN CRUZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST
PHILADELPHIA PA
19107-5002
US

IV. Provider business mailing address

273 GREENLAND AVE
EWING NJ
08638-3629
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax:
Mailing address:
  • Phone: 327-423-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS024778
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: