Provider Demographics
NPI:1174832240
Name:D'CRUZ, SMITHA OOMMEN
Entity Type:Individual
Prefix:MRS
First Name:SMITHA
Middle Name:OOMMEN
Last Name:D'CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SAGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-2153
Mailing Address - Country:US
Mailing Address - Phone:718-698-6721
Mailing Address - Fax:
Practice Address - Street 1:72 SAGAMORE RD
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-2153
Practice Address - Country:US
Practice Address - Phone:718-698-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005545-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist