Provider Demographics
NPI:1467642140
Name:IMELDA CRUZ-BANTING, MD, PC
Entity Type:Organization
Organization Name:IMELDA CRUZ-BANTING, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:MANGAHAS
Authorized Official - Last Name:CRUZ-BANTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-779-3710
Mailing Address - Street 1:12 APPLE CT
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5540
Mailing Address - Country:US
Mailing Address - Phone:914-779-3710
Mailing Address - Fax:718-944-6266
Practice Address - Street 1:108 VAN GUILDER AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5406
Practice Address - Country:US
Practice Address - Phone:914-712-3144
Practice Address - Fax:718-944-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212537261Q00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty