Basic Information
| Provider Information | |||||||||
| NPI: | 1164864237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE LA CRUZ | ||||||||
| FirstName: | MAGDALENA | ||||||||
| MiddleName: | SOFIA | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168752904 | ||||||||
| FaxNumber: | 7168756717 | ||||||||
| Practice Location | |||||||||
| Address1: | 532 BLOOMING GROVE TPKE | ||||||||
| Address2: | |||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455627285 | ||||||||
| FaxNumber: | 8455625779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2013 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 000871 | IA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | 000871 | IA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.