Provider Demographics
NPI:1720819261
Name:CRUZ, VAN GABRIEL S (PT, DPT)
Entity type:Individual
Prefix:
First Name:VAN GABRIEL
Middle Name:S
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7064 YELLOWSTONE BLVD APT 4E
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3564
Mailing Address - Country:US
Mailing Address - Phone:929-641-7608
Mailing Address - Fax:
Practice Address - Street 1:7064 YELLOWSTONE BLVD APT 4E
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3564
Practice Address - Country:US
Practice Address - Phone:929-641-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist