Provider Demographics
NPI:1992779532
Name:CRUZ, HONORIO M (MD)
Entity type:Individual
Prefix:DR
First Name:HONORIO
Middle Name:M
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2521
Mailing Address - Country:US
Mailing Address - Phone:732-431-9191
Mailing Address - Fax:732-431-5261
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2521
Practice Address - Country:US
Practice Address - Phone:732-431-9191
Practice Address - Fax:732-431-5261
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02464100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD90413Medicare UPIN