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General NPI Number Information
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NPI Number | 1326361437
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Entity Type | Organization
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Legal Business Name | ALFREDO B. CRUZ, MD, PC
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 45 2ND ST
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City | TROY
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State | NY
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Zip | 12180-3928
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Country | US
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Telephone | 518-272-7191
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Fax | 518-272-7234
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Provider Business Mailing Address
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Address Line | 45 2ND ST
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City | TROY
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State | NY
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Zip | 12180-3928
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Country | US
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Telephone | 518-272-7191
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Fax | 518-272-7234
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Authorized Official
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Title or Position | EMPLOYER
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Name | DR. ALFREDO BAMBA CRUZ
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Credential | MD
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Telephone | 518-272-7191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 142744
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License Number State | NY
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