Provider Demographics
NPI:1750116844
Name:RUTOWICZ DELACRUZ, CHRISTINA A (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:A
Last Name:RUTOWICZ DELACRUZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:PICCIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-0012
Mailing Address - Country:US
Mailing Address - Phone:631-924-0008
Mailing Address - Fax:
Practice Address - Street 1:35 LONGWOOD RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2045
Practice Address - Country:US
Practice Address - Phone:631-924-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302680-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse