1639118862 NPI number — DR. AVELINO CRUZ M.D.

Table of content: DR. AVELINO CRUZ M.D. (NPI 1639118862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639118862 NPI number — DR. AVELINO CRUZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
AVELINO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639118862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 TUCKAHOE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARMORA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08223-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-390-2632
Provider Business Mailing Address Fax Number:
609-390-9210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 TUCKAHOE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARMORA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08223-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-390-2632
Provider Business Practice Location Address Fax Number:
609-390-9210
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA33741 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 223847323 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223847323 . This is a "ATLANTICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223847323 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223847323 . This is a "ULLICARE/DEVON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 031261 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20632 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223847323 . This is a "HEREIU WELFARE FUND" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3078467 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 127588 . This is a "NATIONWIDE HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1035942 . This is a "NJ HEALTH/HORIZON MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1K9679 . This is a "HEALTHNET OF NJ/CARPENTER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 216162000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223847323 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0952303 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10974 . This is a "AETNA/US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 207857 . This is a "US FAMILY HEALTH PLAN/TRI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223847323 . This is a "HORIZON BLUE CROSS/BLUE S" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 31224689 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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