=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073741294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDLIN CRUZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2009
-----------------------------------------------------
Last Update Date | 06/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 E 58TH ST 506
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-750-4590
-----------------------------------------------------
Fax | 212-751-1752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 5TH AVE APT 2F
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10026-2585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-750-4590
-----------------------------------------------------
Fax | 212-751-1752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 025175-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------