Provider Demographics
NPI:1417151994
Name:CRUZ, IMELDA GINA LAFORTEZA (APN)
Entity Type:Individual
Prefix:MS
First Name:IMELDA GINA
Middle Name:LAFORTEZA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:LAFORTEZA
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:12 WOODHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1468
Mailing Address - Country:US
Mailing Address - Phone:973-972-9371
Mailing Address - Fax:973-972-0092
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:SUITE 7600
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07101
Practice Address - Country:US
Practice Address - Phone:973-972-9371
Practice Address - Fax:973-972-0092
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00045500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily