Provider Demographics
NPI:1376328989
Name:CRUZ, JAIME
Entity Type:Individual
Prefix:MRS
First Name:JAIME
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 1:24 SKUNKS MISERY RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1320
Mailing Address - Country:US
Mailing Address - Phone:917-804-1259
Mailing Address - Fax:
Practice Address - Street 1:191 FOREST AVE
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2143
Practice Address - Country:US
Practice Address - Phone:516-827-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist