Provider Demographics
NPI:1649542077
Name:AVELINA FLORES, M.D.P.C.
Entity type:Organization
Organization Name:AVELINA FLORES, M.D.P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN INTERNAL MEDICINE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVELINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERNANDO-FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-971-1711
Mailing Address - Street 1:411 ROUTE 9 STE 6
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-2818
Mailing Address - Country:US
Mailing Address - Phone:609-971-1711
Mailing Address - Fax:609-971-3390
Practice Address - Street 1:411 ROUTE 9 STE 6
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2818
Practice Address - Country:US
Practice Address - Phone:609-971-1711
Practice Address - Fax:609-971-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03364100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC509933Medicare UPIN