Provider Demographics
NPI:1114979556
Name:CRUZ, LUIS FELIPE (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FELIPE
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CORNWELL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CTR
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1903
Mailing Address - Country:US
Mailing Address - Phone:516-431-4051
Mailing Address - Fax:718-615-2943
Practice Address - Street 1:1600 CENTRAL AVE FL 5
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4018
Practice Address - Country:US
Practice Address - Phone:718-337-3390
Practice Address - Fax:718-337-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197141208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01626851Medicaid
NY01626851Medicaid
F99494Medicare UPIN
NY91E591Medicare ID - Type Unspecified