Provider Demographics
NPI:1831417609
Name:QUIMOSING-CRUZ, MA. MICHELLE MACLANG (PT)
Entity type:Individual
Prefix:
First Name:MA. MICHELLE
Middle Name:MACLANG
Last Name:QUIMOSING-CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MA MICHELLE
Other - Middle Name:QUIMOSING
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:49 SAINT NICHOLAS TER APT 16A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2730
Mailing Address - Country:US
Mailing Address - Phone:646-233-7050
Mailing Address - Fax:646-233-7050
Practice Address - Street 1:49 SAINT NICHOLAS TER APT 16A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2730
Practice Address - Country:US
Practice Address - Phone:646-233-7050
Practice Address - Fax:646-233-7050
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400059584Medicare PIN