Provider Demographics
NPI:1215387873
Name:CRUZ, GERALYN
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GERALYN
Other - Middle Name:CRUZ
Other - Last Name:ESLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6298 WOODHAVEN BLVD APT 3K
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3349
Mailing Address - Country:US
Mailing Address - Phone:917-480-1535
Mailing Address - Fax:
Practice Address - Street 1:5411 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3452
Practice Address - Country:US
Practice Address - Phone:718-386-6692
Practice Address - Fax:718-386-8342
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03784300183500000X
NY064480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist