Provider Demographics
NPI:1497857379
Name:CRUZ, JUAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 157TH ST
Mailing Address - Street 2:SUITE 46
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7134
Mailing Address - Country:US
Mailing Address - Phone:121-228-1111
Mailing Address - Fax:
Practice Address - Street 1:38 POST AVE
Practice Address - Street 2:APT 43
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5706
Practice Address - Country:US
Practice Address - Phone:917-558-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105571-1173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY587521Medicare ID - Type Unspecified