Provider Demographics
NPI:1417101817
Name:CRUZ, GERARDO SANTIAGO (PT)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:SANTIAGO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25412 84TH RD
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1051
Mailing Address - Country:US
Mailing Address - Phone:646-824-8202
Mailing Address - Fax:
Practice Address - Street 1:25412 84TH RD
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1051
Practice Address - Country:US
Practice Address - Phone:646-824-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019376225100000X
NJ40QA01126500225100000X
VA2305205667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist