1124071824 NPI number — NORMAN CRUZ NP

Table of content: NORMAN CRUZ NP (NPI 1124071824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124071824 NPI number — NORMAN CRUZ NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
NORMAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124071824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STONY BROOK UMC
Provider Second Line Business Mailing Address:
HSC 18-040
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-8191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-7989
Provider Business Mailing Address Fax Number:
631-444-6176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STONY BROOK UMC
Provider Second Line Business Practice Location Address:
HSC 18-040
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11794-8191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-7989
Provider Business Practice Location Address Fax Number:
631-444-6176
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  520603 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F334419 . This is a "FNP LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02940114 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 520603-1 . This is a "RN LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2004004483-22 . This is a "ANCC BOARD CERTIFICATION NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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