Provider Demographics
NPI:1063468320
Name:VIGGIANI, KATHRYN A (CNM)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:VIGGIANI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15378
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07192-5378
Mailing Address - Country:US
Mailing Address - Phone:732-923-7100
Mailing Address - Fax:732-923-7104
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-7100
Practice Address - Fax:732-923-7104
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00042100176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0086681Medicaid
NJQ60985Medicare UPIN
NJ0086681Medicaid