Provider Demographics
NPI:1750566766
Name:RUEDA-MACALUSO, MEDEA A (APRN-C)
Entity type:Individual
Prefix:
First Name:MEDEA
Middle Name:A
Last Name:RUEDA-MACALUSO
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2315
Mailing Address - Country:US
Mailing Address - Phone:732-785-2934
Mailing Address - Fax:
Practice Address - Street 1:495 JACK MARTIN BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7778
Practice Address - Country:US
Practice Address - Phone:732-458-8000
Practice Address - Fax:732-458-8020
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00055600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health