Provider Demographics
NPI:1083915631
Name:JEFFREY, KRISTINA MARIE (BA)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MARIE
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 RARITAN BLVD
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-6012
Mailing Address - Country:US
Mailing Address - Phone:908-295-0727
Mailing Address - Fax:
Practice Address - Street 1:242 RARITAN BLVD
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-6012
Practice Address - Country:US
Practice Address - Phone:908-295-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist