Provider Demographics
NPI:1588783708
Name:CRUZ, ELIZABETH (DPM, PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DPM, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 THORNTON PL
Mailing Address - Street 2:#5E
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4171
Mailing Address - Country:US
Mailing Address - Phone:917-862-8545
Mailing Address - Fax:
Practice Address - Street 1:435 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3506
Practice Address - Country:US
Practice Address - Phone:212-795-3000
Practice Address - Fax:212-795-3263
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005036213E00000X
NY001825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01480033Medicaid
NY01480033Medicaid
NYP75512Medicare ID - Type UnspecifiedDPM MANHATTAN
NY00786Medicare ID - Type UnspecifiedDPM QUEENS