Healthcare Provider Details

I. General information

NPI: 1881283570
Provider Name (Legal Business Name): DOMINIQUE CINTRON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. DOMINIQUE AVERY

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5034 ATLANTIC AVE
MAYS LANDING NJ
08330-2022
US

IV. Provider business mailing address

1 N WHITE HORSE PIKE
HAMMONTON NJ
08037-1875
US

V. Phone/Fax

Practice location:
  • Phone: 609-782-0005
  • Fax: 609-829-3857
Mailing address:
  • Phone: 609-567-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17551000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01095400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01095400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01095400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: