Provider Demographics
NPI:1770927063
Name:CRUZ PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:CRUZ PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIS-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-337-3390
Mailing Address - Street 1:16 CORNWELL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1903
Mailing Address - Country:US
Mailing Address - Phone:917-826-9930
Mailing Address - Fax:
Practice Address - Street 1:1600 CENTRAL AVE 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3621
Practice Address - Country:US
Practice Address - Phone:718-337-3390
Practice Address - Fax:718-337-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013294261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02272719Medicaid