Provider Demographics
NPI:1598716268
Name:PEDRO J. CRUZ, LLC
Entity Type:Organization
Organization Name:PEDRO J. CRUZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUZ-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-273-0250
Mailing Address - Street 1:1301 TRUMANSBURG ROAD
Mailing Address - Street 2:SUITE L
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-273-0250
Mailing Address - Fax:607-273-2920
Practice Address - Street 1:1301 TRUMANSBURG ROAD
Practice Address - Street 2:SUITE L
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-273-0250
Practice Address - Fax:607-273-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0202Medicare PIN