Provider Demographics
NPI:1093605842
Name:CRUZ, ENRICO GABRIEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ENRICO
Middle Name:GABRIEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1211
Mailing Address - Country:US
Mailing Address - Phone:201-688-9398
Mailing Address - Fax:
Practice Address - Street 1:15 FRANKLIN ST STE D
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2146
Practice Address - Country:US
Practice Address - Phone:201-525-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01299500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist