MEDICARE: DR. GRACIANO F. AVENDANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	25MA05970000	NJ

General Provider Information

NPI Number	:	1104999705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACIANO F. AVENDANO M.D.

Provider Business Mailing Address
First Line	:	465 CRANBURY RD
Second Line	:	SUITE 201
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-7600
Country	:	US
Telephone Number	:	732-613-1988
Fax Number	:	732-651-7734

Provider Business Practice Location Address
First Line	:	465 CRANBURY RD
Second Line	:	SUITE 201
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-7600
Country	:	US
Telephone Number	:	732-613-1988
Fax Number	:	732-651-7734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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