MEDICARE: KEVIN CRUZ MSED

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
1	103K00000X	Behavior Analyst	1909102251	NY

General Provider Information

NPI Number	:	1427944701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN CRUZ MSED

Provider Business Mailing Address
First Line	:	2200 CEDAR AVE APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5521
Country	:	US
Telephone Number	:	917-374-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 CEDAR AVE APT 1
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-5521
Country	:	US
Telephone Number	:	917-374-2112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2025
Last Update Date	:	06/14/2025

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