Provider Demographics
NPI:1346240660
Name:MATTEI, CRUZ A (MD)
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:A
Last Name:MATTEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:ANTONIA
Other - Last Name:MATTEI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1100 WESCOTT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-788-6535
Mailing Address - Fax:908-788-6536
Practice Address - Street 1:1100 WESCOTT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4600
Practice Address - Country:US
Practice Address - Phone:908-788-6535
Practice Address - Fax:908-788-6536
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7025505Medicaid
NJ879274M5DMedicare ID - Type Unspecified
NJ7025505Medicaid