Provider Demographics
NPI:1639118862
Name:CRUZ, AVELINO (MD)
Entity Type:Individual
Prefix:DR
First Name:AVELINO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223847323OtherMUTUAL OF OMAHA
NJ223847323OtherATLANTICARE
NJ223847323OtherHEALTHNET
NJ223847323OtherULLICARE/DEVON
NJ031261OtherAMERIHEALTH ADMINISTRATOR
NJ20632OtherAMERIGROUP
NJ223847323OtherHEREIU WELFARE FUND
NJP3078467OtherOXFORD
NJ127588OtherNATIONWIDE HEALTH PLANS
NJ1035942OtherNJ HEALTH/HORIZON MERCY
NJ1K9679OtherHEALTHNET OF NJ/CARPENTER
NJ216162000OtherAMERIHEALTH
NJ223847323OtherUNITED HEALTH CARE
NJ0952303Medicaid
NJ10974OtherAETNA/US HEALTHCARE
NJ207857OtherUS FAMILY HEALTH PLAN/TRI
NJ223847323OtherHORIZON BLUE CROSS/BLUE S
NJ31224689OtherCIGNA
NJ1K9679OtherHEALTHNET OF NJ/CARPENTER
NJ570183Medicare ID - Type Unspecified