Healthcare Provider Details

I. General information

NPI: 1598240459
Provider Name (Legal Business Name): JORGE CRUZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD
TEANECK NJ
07666-4245
US

IV. Provider business mailing address

718 TEANECK RD
TEANECK NJ
07666-4245
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-3101
  • Fax:
Mailing address:
  • Phone: 201-833-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00861200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: