Provider Demographics
NPI:1497819940
Name:XENACHIS, CRISTINA Z (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:Z
Last Name:XENACHIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-4104
Mailing Address - Country:US
Mailing Address - Phone:732-765-1166
Mailing Address - Fax:732-765-0027
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4104
Practice Address - Country:US
Practice Address - Phone:732-765-1166
Practice Address - Fax:732-765-0027
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66830207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8028800Medicaid
NJG93779Medicare UPIN
NJ8028800Medicaid