Provider Demographics
NPI:1366636300
Name:MCKENNA, CRISTIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CRISTIN
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EAGLE ROCK AVE STE 154
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3168
Mailing Address - Country:US
Mailing Address - Phone:201-447-4772
Mailing Address - Fax:973-243-6861
Practice Address - Street 1:120 EAGLE ROCK AVE STE 154
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3168
Practice Address - Country:US
Practice Address - Phone:201-447-4772
Practice Address - Fax:973-243-6861
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08280900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation