Provider Demographics
NPI:1457687766
Name:CRUZ, DAVID SAMUEL SIEGA (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID SAMUEL
Middle Name:SIEGA
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 1:3770 63RD ST
Mailing Address - Street 2:APT. 2-B
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2634
Mailing Address - Country:US
Mailing Address - Phone:646-379-0240
Mailing Address - Fax:
Practice Address - Street 1:3770 63RD ST
Practice Address - Street 2:APT. 2-B
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2634
Practice Address - Country:US
Practice Address - Phone:646-379-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist