Provider Demographics
NPI:1164655486
Name:FAMULARO, CRISTIN ASHLEY (APN)
Entity Type:Individual
Prefix:MISS
First Name:CRISTIN
Middle Name:ASHLEY
Last Name:FAMULARO
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 1:465 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3548
Mailing Address - Country:US
Mailing Address - Phone:973-587-8040
Mailing Address - Fax:
Practice Address - Street 1:80 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8034
Practice Address - Country:US
Practice Address - Phone:201-913-7146
Practice Address - Fax:201-327-9981
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ002012002084P0804X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics