Provider Demographics
NPI:1689746828
Name:GIAMBALVO, CRISTINA
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:GIAMBALVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 OLD HOOK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3117
Mailing Address - Country:US
Mailing Address - Phone:201-358-0505
Mailing Address - Fax:201-497-1133
Practice Address - Street 1:270 OLD HOOK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3117
Practice Address - Country:US
Practice Address - Phone:201-358-0505
Practice Address - Fax:201-497-1133
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31601176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25ME00031601OtherNJ LICENSE