Provider Demographics
NPI:1508989872
Name:AVELINO CRUZ MD PC
Entity Type:Organization
Organization Name:AVELINO CRUZ MD PC
Other - Org Name:AVELINO N. CRUZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVELINO
Authorized Official - Middle Name:N
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-390-2632
Mailing Address - Street 1:60 TUCKAHOE RD
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1206
Mailing Address - Country:US
Mailing Address - Phone:609-390-2632
Mailing Address - Fax:609-390-9210
Practice Address - Street 1:60 TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1206
Practice Address - Country:US
Practice Address - Phone:609-390-2632
Practice Address - Fax:609-390-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33741207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0952303Medicaid
NJ0952303Medicaid
NJD13981Medicare UPIN