Provider Demographics
NPI:1104999705
Name:AVENDANO, GRACIANO F (MD)
Entity type:Individual
Prefix:DR
First Name:GRACIANO
Middle Name:F
Last Name:AVENDANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:F
Other - Last Name:AVENDANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:465 CRANBURY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-7600
Mailing Address - Country:US
Mailing Address - Phone:732-613-1988
Mailing Address - Fax:732-651-7734
Practice Address - Street 1:465 CRANBURY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-7600
Practice Address - Country:US
Practice Address - Phone:732-613-1988
Practice Address - Fax:732-651-7734
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05970000207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG48983Medicare UPIN
NJ900531DS2Medicare ID - Type Unspecified