Provider Demographics
NPI:1043295579
Name:CRUZ-ENCARNACION, MERLE CORREA (MD)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:CORREA
Last Name:CRUZ-ENCARNACION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SAINT PAULS AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3724
Mailing Address - Country:US
Mailing Address - Phone:201-653-7533
Mailing Address - Fax:201-653-7960
Practice Address - Street 1:201 SAINT PAULS AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3724
Practice Address - Country:US
Practice Address - Phone:201-653-7533
Practice Address - Fax:201-653-7960
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA044053207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2067609Medicaid
NJ2067609Medicaid
NJ456162Medicare ID - Type Unspecified