Individual
JESENIA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6950 S TRANSIT RD, LOCKPORT, NY 14094-6333
(716) 630-1143
(716) 817-1765
Mailing address
425 ESSJAY RD, STE 170, WILLIAMSVILLE, NY 14221-5782
(716) 630-1219
(716) 817-1726
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
228571
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00027387401
UNIVERA
NY
01
—
060720000023
FIDELIS
NY
01
—
11489395
CAQH
NY
01
—
175204BF
PREFERRED CARE
NY
01
—
P010238304
BLUE CHOICE
NY
Enumeration date
05/17/2006
Last updated
01/08/2024
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