Provider Demographics
NPI:1972565075
Name:CRUZ, ELSA PAGULA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:PAGULA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3278 STEINWAY ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4032
Mailing Address - Country:US
Mailing Address - Phone:718-204-8448
Mailing Address - Fax:718-204-8025
Practice Address - Street 1:3278 STEINWAY ST
Practice Address - Street 2:STE 1
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4032
Practice Address - Country:US
Practice Address - Phone:718-204-8448
Practice Address - Fax:718-204-8025
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY216727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G67682Medicare UPIN
NY02063954Medicare ID - Type Unspecified