Provider Demographics
NPI:1659127892
Name:COSANO CRUZ, CARMEN R (LPN)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:R
Last Name:COSANO CRUZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 N HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2885
Mailing Address - Country:US
Mailing Address - Phone:631-836-5065
Mailing Address - Fax:
Practice Address - Street 1:87 N HOWELL AVE
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2885
Practice Address - Country:US
Practice Address - Phone:631-836-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336919-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse