Provider Demographics
NPI:1629431234
Name:RODRIGUEZ, CRUZ
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FLATBUSH AVE
Mailing Address - Street 2:SOUTH BEACH PSYCHIATRIC CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1101
Mailing Address - Country:US
Mailing Address - Phone:718-875-1420
Mailing Address - Fax:718-874-5496
Practice Address - Street 1:25 FLATBUSH AVE
Practice Address - Street 2:SOUTH BEACH PSYCHIATRIC CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1101
Practice Address - Country:US
Practice Address - Phone:718-875-1420
Practice Address - Fax:718-874-5496
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00769306Medicaid