Provider Demographics
NPI:1194932780
Name:CRUZ, SILFA N (OPTICIAN11031947)
Entity type:Individual
Prefix:MRS
First Name:SILFA
Middle Name:N
Last Name:CRUZ
Suffix:
Gender:F
Credentials:OPTICIAN11031947
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4315
Mailing Address - Country:US
Mailing Address - Phone:732-442-8566
Mailing Address - Fax:
Practice Address - Street 1:121 MARKET ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4315
Practice Address - Country:US
Practice Address - Phone:732-442-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00169700156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3286606Medicaid