Provider Demographics
NPI:1467465203
Name:INGRASSIA-SQUIERS, KERI LYNN (DO)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LYNN
Last Name:INGRASSIA-SQUIERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:LYNN
Other - Last Name:INGRASSIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 95000 LB# 7550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:HASTINGS SQUARE PLAZA #5
Practice Address - Street 2:SCHOOLEYS MOUNTAIN ROAD
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-979-0050
Practice Address - Fax:908-979-0044
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB72580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
090967Medicare ID - Type Unspecified
H93512Medicare UPIN