Provider Demographics
NPI:1689602369
Name:DELA CRUZ, DANNA GLORE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:GLORE MICHELLE
Last Name:DELA CRUZ
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 1:731 LACEY ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731
Mailing Address - Country:US
Mailing Address - Phone:609-242-0040
Mailing Address - Fax:609-242-8119
Practice Address - Street 1:731 LACEY ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731
Practice Address - Country:US
Practice Address - Phone:609-242-0040
Practice Address - Fax:609-242-8119
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07164600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038318Medicaid
NJ081257Medicare ID - Type Unspecified
I11592Medicare UPIN