Provider Demographics
NPI:1912397506
Name:CRUZATE, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:CRUZATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MANHASSET AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3729
Mailing Address - Country:US
Mailing Address - Phone:631-974-7200
Mailing Address - Fax:
Practice Address - Street 1:47 MANHASSET AVE
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3729
Practice Address - Country:US
Practice Address - Phone:631-974-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician