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General NPI Number Information
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NPI Number | 1942529755
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Entity Type | Individual
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Provider Name | MR. CARLOS MANUEL CRUZ JR.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 7410 35TH AVE SUITE 107W
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-8197
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Country | US
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Telephone | 718-672-1538
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 SARATOGA LN
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City | FISHKILL
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State | NY
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Zip | 12524-4952
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Country | US
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Telephone | 914-261-7816
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 065815
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License Number State | NY
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