Provider Demographics
NPI:1235504846
Name:CRUZ, EGDALY
Entity Type:Individual
Prefix:
First Name:EGDALY
Middle Name:
Last Name: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 1:1847 HARRISON AVE # 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4530
Mailing Address - Country:US
Mailing Address - Phone:646-691-8311
Mailing Address - Fax:
Practice Address - Street 1:1847 HARRISON AVE # 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4530
Practice Address - Country:US
Practice Address - Phone:646-691-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator