Provider Demographics
NPI:1558648790
Name:MANCINI, KRISTINA DANIELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:DANIELLE
Last Name:MANCINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GILL LN
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3059
Mailing Address - Country:US
Mailing Address - Phone:732-404-1580
Mailing Address - Fax:
Practice Address - Street 1:400 GILL LN
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3059
Practice Address - Country:US
Practice Address - Phone:732-404-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00260200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant