Provider Demographics
NPI:1881622207
Name:CRUZ, REX ONGOCO (LPT)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:ONGOCO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 VETERANS MEMORIAL HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2937
Mailing Address - Country:US
Mailing Address - Phone:631-245-7210
Mailing Address - Fax:
Practice Address - Street 1:800 VETERANS MEMORIAL HWY STE 120
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2937
Practice Address - Country:US
Practice Address - Phone:631-245-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1881622207OtherNPI