Healthcare Provider Details

I. General information

NPI: 1215929153
Provider Name (Legal Business Name): BERNARDO VALOEZ CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 W PARKWAY
POMPTON PLAINS NJ
07444-1647
US

IV. Provider business mailing address

PO BOX 450
CLIFFSIDE PARK NJ
07010-0450
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-5140
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA04516800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: