Provider Demographics
NPI:1124378385
Name:CROSS, MARGUERITA (MS RD CDN)
Entity Type:Individual
Prefix:
First Name:MARGUERITA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 1ST AVE APT 5E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4339
Mailing Address - Country:US
Mailing Address - Phone:212-369-4521
Mailing Address - Fax:
Practice Address - Street 1:2075 FIST AVE APT 5E
Practice Address - Street 2:
Practice Address - City:N.Y.
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-369-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY624060133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered