Healthcare Provider Details

I. General information

NPI: 1609253079
Provider Name (Legal Business Name): MARIAWY RIOLLANO CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JSUMC 19 DAVIS AVE, HOPE TOWER NEPTUNE, NJ 07753
NEPTUNE NJ
07753
US

IV. Provider business mailing address

JSUMC 19 DAVIS AVE, HOPE TOWER
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number25MA11088500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11088500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: