Active NPI
Esau Cruz Gutierrez, DDS
- Dentist
- Stony Brook, NY
National Provider Identifier
1275289357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 063384
- Practice address
- Suny at Stony Brook at Stony Brook 151 Westchester Hall
Stony Brook, NY 11794-0001 - Phone
- (845) 857-7574
- NPI assigned
- Feb 27, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 063384 | NY | Primary |
Addresses
Primary practice location
Suny at Stony Brook at Stony Brook 151 Westchester Hall
Stony Brook, NY 11794-0001
Mailing address
110 Greene Ave
Port Jefferson Station, NY 11776-4314
Phone (845) 857-7574
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 063384 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722384000000",
"number": "1275289357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 GREENE AVE",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117764314",
"telephone_number": "845-857-7574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SUNY AT STONY BROOK AT STONY BROOK 151 WESTCHESTER HALL",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117940001",
"telephone_number": "845-857-7574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ GUTIERREZ",
"first_name": "ESAU",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-27",
"last_updated": "2024-07-31",
"certification_date": "2024-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "063384",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.