Provider Demographics
NPI:1255357349
Name:CORNEL-AVENDANO, BEVERLY (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CORNEL-AVENDANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:C
Other - Last Name:AVENDANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:233 MIDDLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1957
Mailing Address - Country:US
Mailing Address - Phone:732-888-0411
Mailing Address - Fax:732-888-3909
Practice Address - Street 1:233 MIDDLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1957
Practice Address - Country:US
Practice Address - Phone:732-888-0411
Practice Address - Fax:732-888-3909
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64381207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ032809Medicare ID - Type UnspecifiedMEDICARE ID#
NJH06118Medicare UPIN