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NPI Code Detail

MEDICARE: IDALIA CRUZ M.D.

MEDICARE: IDALIA CRUZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician172165NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040426033250OTHERNYFIDELIS PROVIDER NUMBER

General Provider Information

NPI Number : 1124134770
Entity Type Code : Individual
Provider Name (Legal Business Name) : IDALIA CRUZ M.D.
Provider Business Mailing Address
First Line : 145 W 15TH ST
Second Line : 2ND FLOOR
City : NEW YORK
State : NY
Zip : 10011-6701
Country : US
Telephone Number : 212-924-6324
Fax Number : 212-691-5635
Provider Business Practice Location Address
First Line : 28 DEBEVOISE ST STE 5
Second Line :
City : BROOKLYN
State : NY
Zip : 11206-4194
Country : US
Telephone Number : 718-963-4430
Fax Number : 646-398-2794
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 03/19/2019

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