Provider Demographics
NPI:1609228899
Name:CRUZ, LYDIA (MS SED)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS SED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4204
Mailing Address - Country:US
Mailing Address - Phone:646-522-9306
Mailing Address - Fax:
Practice Address - Street 1:2424 BEECH ST
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4204
Practice Address - Country:US
Practice Address - Phone:646-522-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator