Provider Demographics
NPI:1205023546
Name:CRUZ, FREDESWINDA POLICARPIO (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDESWINDA
Middle Name:POLICARPIO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GADSEN PLACE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-698-3333
Mailing Address - Fax:718-698-2691
Practice Address - Street 1:4 GADSEN PLACE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-698-3333
Practice Address - Fax:718-698-2691
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA023641207Q00000X
NY106163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0052638OtherGHI
NY62872OtherEMPIRE BLUE CROSS BLUE SH
NJ445369Medicare UPIN