MEDICARE: MICHELLE 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	:	1760630818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CRUZ

Provider Business Mailing Address
First Line	:	25 CHAPEL ST STE 901
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1954
Country	:	US
Telephone Number	:	718-398-0153
Fax Number	:	718-623-2531

Provider Business Practice Location Address
First Line	:	25 CHAPEL ST STE 901
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1954
Country	:	US
Telephone Number	:	718-398-0153
Fax Number	:	718-623-2531

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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Directions to “ MICHELLE CRUZ ” Practice Location

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