Provider Demographics
NPI:1629001482
Name:CUETO, IRENE LEAH (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:LEAH
Last Name:CUETO
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 1:2279 ROUTE 33
Mailing Address - Street 2:SUITE 505
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2279 HIGHWAY 33
Practice Address - Street 2:SUITE 505
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1750
Practice Address - Country:US
Practice Address - Phone:609-249-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06511100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7261802Medicaid
G63340Medicare UPIN
005548Medicare ID - Type Unspecified