MEDICARE: AVELINA FERNANDO FLORES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA033641	NJ

General Provider Information

NPI Number	:	1104899582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVELINA FERNANDO FLORES MD

Provider Business Mailing Address
First Line	:	411 RT9
Second Line	:	SUITE 6
City	:	LANOKA HARBOR
State	:	NJ
Zip	:	08734
Country	:	US
Telephone Number	:	609-971-1711
Fax Number	:	609-971-3390

Provider Business Practice Location Address
First Line	:	411 RTE 9
Second Line	:	STE 6
City	:	LANOKA HARBOR
State	:	NJ
Zip	:	08734
Country	:	US
Telephone Number	:	609-971-1711
Fax Number	:	609-971-3390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/09/2012

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