Provider Demographics
NPI:1205605425
Name:HERRERA, CRISTEL A (MT)
Entity type:Individual
Prefix:MISS
First Name:CRISTEL
Middle Name:A
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MISS
Other - First Name:CRISTEL
Other - Middle Name:ANDREA
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT
Mailing Address - Street 1:1117 ROUTE 46 STE 203
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2450
Mailing Address - Country:US
Mailing Address - Phone:973-954-5113
Mailing Address - Fax:866-549-5687
Practice Address - Street 1:1117 ROUTE 46 STE E203
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2449
Practice Address - Country:US
Practice Address - Phone:973-954-5113
Practice Address - Fax:866-549-5687
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01174300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty