Provider Demographics
NPI:1780878595
Name:DELA CRUZ, RONALD ALLAN ENRIQUEZ (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD ALLAN
Middle Name:ENRIQUEZ
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27005 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1402
Mailing Address - Country:US
Mailing Address - Phone:718-470-7323
Mailing Address - Fax:718-343-3429
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-7323
Practice Address - Fax:718-343-3429
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432350208600000X
CAA114371208600000X
NY263868208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEM992ZOtherMEDICARE INDIVIDUAL PTAN