MEDICARE: DR. ANDRES CRUZ ANTONIO MD

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	207R00000X	Internal Medicine Physician	139555	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437116746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRES CRUZ ANTONIO MD

Provider Business Mailing Address
First Line	:	625 GRAMATAN AVENUE
Second Line	:
City	:	MT VERNON
State	:	NY
Zip	:	10552
Country	:	US
Telephone Number	:	914-668-9164
Fax Number	:	914-664-2610

Provider Business Practice Location Address
First Line	:	625 GRAMATAN AVENUE
Second Line	:
City	:	MT VERNON
State	:	NY
Zip	:	10552
Country	:	US
Telephone Number	:	914-668-9164
Fax Number	:	914-664-2610

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/06/2010

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