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NPI Code Detail

MEDICARE: DR. IMELDA MANGAHAS CRUZ-BANTING M.D.

MEDICARE: DR. IMELDA MANGAHAS CRUZ-BANTING 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
1208100000XPhysical Medicine & Rehabilitation Physician212537NY

General Provider Information

NPI Number : 1760458137
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IMELDA MANGAHAS CRUZ-BANTING M.D.
Provider Business Mailing Address
First Line : 729 PELHAM PKWY N
Second Line :
City : BRONX
State : NY
Zip : 10467-9506
Country : US
Telephone Number : 718-944-6262
Fax Number : 718-944-6266
Provider Business Practice Location Address
First Line : 729 PELHAM PKWY N
Second Line :
City : BRONX
State : NY
Zip : 10467-9506
Country : US
Telephone Number : 718-944-6262
Fax Number : 718-944-6266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 04/01/2014

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