Provider Demographics
NPI:1811420110
Name:MICELI, CRISTINA (DO)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:MICELI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WASHINGTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4907
Mailing Address - Country:US
Mailing Address - Phone:201-659-7700
Mailing Address - Fax:
Practice Address - Street 1:609 WASHINGTON ST FL 2
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4907
Practice Address - Country:US
Practice Address - Phone:201-659-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11199200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0811467Medicaid