MEDICARE: CLARIBEL 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1659634384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARIBEL CRUZ

Provider Business Mailing Address
First Line	:	255 EXECUTIVE DR STE 105LL
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1718
Country	:	US
Telephone Number	:	718-706-7500
Fax Number	:	718-706-9595

Provider Business Practice Location Address
First Line	:	3711 35TH AVE STE 3C
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11101-1441
Country	:	US
Telephone Number	:	718-706-7500
Fax Number	:	718-706-9595

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

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	06/18/2012

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Directions to “ CLARIBEL CRUZ ” Practice Location

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