Provider Demographics
NPI:1326361437
Name:ALFREDO B. CRUZ, MD, PC
Entity Type:Organization
Organization Name:ALFREDO B. CRUZ, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:BAMBA
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-7191
Mailing Address - Street 1:45 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3928
Mailing Address - Country:US
Mailing Address - Phone:518-272-7191
Mailing Address - Fax:518-272-7234
Practice Address - Street 1:45 2ND ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3928
Practice Address - Country:US
Practice Address - Phone:518-272-7191
Practice Address - Fax:518-272-7234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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NY000408110001OtherBSNENY
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NY10000414OtherCDPHP
NY79E301OtherBC
NY08287OtherMVP
NY37781BMedicare PIN