Provider Demographics
NPI:1821038381
Name:LIS-CRUZ, MALGORZATA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MALGORZATA
Middle Name:
Last Name:LIS-CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CORNWELL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1903
Mailing Address - Country:US
Mailing Address - Phone:516-431-4051
Mailing Address - Fax:
Practice Address - Street 1:1600 CENTRAL AVE 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-337-3390
Practice Address - Fax:718-337-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist