Provider Demographics
NPI:1760458137
Name:CRUZ-BANTING, IMELDA MANGAHAS (MD)
Entity Type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:MANGAHAS
Last Name:CRUZ-BANTING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:729 PELHAM PKWY N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-9506
Mailing Address - Country:US
Mailing Address - Phone:718-944-6262
Mailing Address - Fax:718-944-6266
Practice Address - Street 1:729 PELHAM PKWY N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9506
Practice Address - Country:US
Practice Address - Phone:718-944-6262
Practice Address - Fax:718-944-6266
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY212537208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG97636Medicare UPIN