Individual
MS. MASSIEL DELACRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
359 CENTRE ST, SUITE1, NUTLEY, NJ 07110-2791
(973) 667-1500
Mailing address
5 RUTGERS ST, WEST ORANGE, NJ 07052-2511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00201300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00201300
LICENSE
NJ
Enumeration date
09/26/2008
Last updated
12/08/2012
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