MEDICARE: MRS. LILLIAN IVETTE MILLER-CRUZ

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	225100000X	Physical Therapist	009175	NY

General Provider Information

NPI Number	:	1558878645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILLIAN IVETTE MILLER-CRUZ

Provider Business Mailing Address
First Line	:	136 SURF DR
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-2536
Country	:	US
Telephone Number	:	787-360-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 E TREMONT AVE # 10461
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-5704
Country	:	US
Telephone Number	:	718-904-4200
Fax Number	:

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

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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