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General NPI Number Information
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NPI Number | 1043876253
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Entity Type | Individual
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Provider Name | DAMARYS CRUZ FNP-BC, MSN
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 297 16TH AVE
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City | NEWARK
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State | NJ
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Zip | 07103-1104
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Country | US
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Telephone | 973-374-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 135 MAPLEWOOD AVE
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City | WAYNE
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State | NJ
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Zip | 07470-5133
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Country | US
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Telephone | 973-460-6671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00911800
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License Number State | NJ
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