Provider Demographics
NPI:1013335439
Name:CRUZ, NICOLE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 EAST 70TH STREET, STARR 341
Mailing Address - Street 2:WEILL CORNELL INTERNAL MEDICINE ASSOCIATES
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0000
Mailing Address - Country:US
Mailing Address - Phone:646-962-2065
Mailing Address - Fax:212-821-0758
Practice Address - Street 1:505 EAST 70TH STREET
Practice Address - Street 2:WEILL CORNELL INTERNAL MEDICINE ASSOCIATES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-746-9663
Practice Address - Fax:212-746-3609
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY288580207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program