Provider Demographics
NPI:1871697292
Name:CRUZ REY, AZUCENA C (MD)
Entity type:Individual
Prefix:DR
First Name:AZUCENA
Middle Name:C
Last Name:CRUZ REY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LONG DR
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4717
Mailing Address - Country:US
Mailing Address - Phone:516-489-2287
Mailing Address - Fax:
Practice Address - Street 1:327 BEACH 19TH ST # CP 4
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4423
Practice Address - Country:US
Practice Address - Phone:718-869-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1142012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00424057Medicaid
NY01G131Medicare ID - Type Unspecified
NY00424057Medicaid