MEDICARE: DR. MARGARET ROSE DE CRUZ DC, LMT

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	101YM0800X	Mental Health Counselor	003651-1	NY
2	111NR0400X	Rehabilitation Chiropractor	X005167	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0020413	OTHER	NY	GHI

General Provider Information

NPI Number	:	1770774879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET ROSE DE CRUZ DC, LMT

Provider Business Mailing Address
First Line	:	400A PROSPECT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5609
Country	:	US
Telephone Number	:	718-499-7258
Fax Number	:

Provider Business Practice Location Address
First Line	:	400A PROSPECT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5609
Country	:	US
Telephone Number	:	718-499-7258
Fax Number	:

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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