Provider Demographics
NPI:1477091643
Name:DELACRUZ, MARIE (RN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:DOMINIQUE
Other - Last Name:DELACRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:501 FRANKLIN AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5807
Mailing Address - Country:US
Mailing Address - Phone:516-267-5505
Mailing Address - Fax:
Practice Address - Street 1:501 FRANKLIN AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5807
Practice Address - Country:US
Practice Address - Phone:516-267-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY540949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse