Provider Demographics
NPI:1043390131
Name:CRUZ, MADELINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HEWITT ST
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1409
Mailing Address - Country:US
Mailing Address - Phone:845-786-3830
Mailing Address - Fax:845-786-3830
Practice Address - Street 1:3 HEWITT ST
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1409
Practice Address - Country:US
Practice Address - Phone:845-786-3830
Practice Address - Fax:845-786-3830
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005347213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2017970OtherUNITED HEALTHCARE
NY01742525Medicaid
NY4233980001Medicare NSC
NY01742525Medicaid
NYP00621Medicare ID - Type Unspecified