Provider Demographics
NPI:1376745737
Name:CRUZ, JULISSA (MD)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:
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 1:237 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2403
Mailing Address - Country:US
Mailing Address - Phone:718-833-5886
Mailing Address - Fax:718-759-0068
Practice Address - Street 1:237 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2403
Practice Address - Country:US
Practice Address - Phone:718-833-5886
Practice Address - Fax:718-759-0068
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244251207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02904474Medicaid
NYA400004850Medicare PIN
NYA400001847Medicare PIN