Active NPI
Keith Cruise, PHD, MLS
- Clinical Psychologist
- Bronx, NY
National Provider Identifier
1306615265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 016973
- Practice address
- Department of Psychology
441 East Fordham Rd
Bronx, NY 10458 - Phone
- (718) 817-3883
- NPI assigned
- Dec 20, 2023
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 016973 | NY | Primary |
Addresses
Primary practice location
Department of Psychology
441 East Fordham Rd
Bronx, NY 10458
Mailing address
343 E 30TH St Apt 15N
New York, NY 10016-6439
Phone (504) 905-5729
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016973 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703030400000",
"number": "1306615265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "343 E 30TH ST APT 15N",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100166439",
"telephone_number": "504-905-5729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "DEPARTMENT OF PSYCHOLOGY",
"address_2": "441 EAST FORDHAM RD",
"city": "BRONX",
"state": "NY",
"postal_code": "10458",
"telephone_number": "718-817-3883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUISE",
"first_name": "KEITH",
"name_prefix": "Dr.",
"credential": "PHD, MLS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-12-20",
"last_updated": "2023-12-20",
"certification_date": "2023-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "016973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.