Provider Demographics
NPI:1124071824
Name:CRUZ, NORMAN (NP)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK UMC
Mailing Address - Street 2:HSC 18-040
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8191
Mailing Address - Country:US
Mailing Address - Phone:631-444-7989
Mailing Address - Fax:631-444-6176
Practice Address - Street 1:STONY BROOK UMC
Practice Address - Street 2:HSC 18-040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8191
Practice Address - Country:US
Practice Address - Phone:631-444-7989
Practice Address - Fax:631-444-6176
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520603363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF334419OtherFNP LICENSE
NY02940114Medicaid
NY520603-1OtherRN LICENSE
NY2004004483-22OtherANCC BOARD CERTIFICATION NUMBER
NY2004004483-22OtherANCC BOARD CERTIFICATION NUMBER
Q72794Medicare UPIN
NY1955G1Medicare PIN