Healthcare Provider Details

I. General information

NPI: 1801461777
Provider Name (Legal Business Name): IVELISSE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 N HARTFORD AVE
ATLANTIC CITY NJ
08401-3512
US

IV. Provider business mailing address

6550 DELILAH RD STE 301
EGG HARBOR TWP NJ
08234-5102
US

V. Phone/Fax

Practice location:
  • Phone: 609-348-1161
  • Fax: 609-383-2868
Mailing address:
  • Phone: 856-725-5514
  • Fax: 609-383-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR14564100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: