Healthcare Provider Details

I. General information

NPI: 1316220759
Provider Name (Legal Business Name): ANA RITA DELACRUZ MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N BROAD ST STE 303
ELIZABETH NJ
07208-2310
US

IV. Provider business mailing address

700 N BROAD ST STE 303
ELIZABETH NJ
07208-2310
US

V. Phone/Fax

Practice location:
  • Phone: 908-662-7697
  • Fax:
Mailing address:
  • Phone: 908-662-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberCT-10502
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00086500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number14-465
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: