Provider Demographics
NPI:1427262427
Name:CRUZ, RICARDO JUAN SIOCHI IV (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:JUAN SIOCHI
Last Name:CRUZ
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:JUAN
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 CARMAN AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1148
Mailing Address - Country:US
Mailing Address - Phone:516-832-7886
Mailing Address - Fax:516-832-7886
Practice Address - Street 1:200 CARMAN AVE APT 1A
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1148
Practice Address - Country:US
Practice Address - Phone:516-832-7886
Practice Address - Fax:516-832-7886
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244031208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation