Provider Demographics
NPI:1710022793
Name:CRUZ, EPIFANIA M (MD)
Entity Type:Individual
Prefix:
First Name:EPIFANIA
Middle Name:M
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:SUITE 605
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-772-4971
Mailing Address - Fax:856-772-1140
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:SUITE 605
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-772-4971
Practice Address - Fax:856-772-1140
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA59969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG224515Medicare UPIN