Provider Demographics
NPI:1043345143
Name:KUNIGONIS, ELAINE MARY (APN)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARY
Last Name:KUNIGONIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWNSP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7730
Mailing Address - Country:US
Mailing Address - Phone:609-653-4286
Mailing Address - Fax:609-653-4286
Practice Address - Street 1:128 CREST HAVEN RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210
Practice Address - Country:US
Practice Address - Phone:609-465-4100
Practice Address - Fax:609-465-7751
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00076300364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0032603Medicaid
S07988Medicare UPIN
NJ0032603Medicaid