Healthcare Provider Details

I. General information

NPI: 1447261896
Provider Name (Legal Business Name): ANTONIO A. DE LA CRUZ, MD., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 BROAD ST
NEWARK NJ
07102-4503
US

IV. Provider business mailing address

25 PORSCHE DR
MATAWAN NJ
07747-3538
US

V. Phone/Fax

Practice location:
  • Phone: 973-622-3890
  • Fax:
Mailing address:
  • Phone: 732-397-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA03502300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number25MA03502300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03502300
License Number StateNJ

VIII. Authorized Official

Name: ANTONIO A. DE LA CRUZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-397-0772