Provider Demographics
NPI:1336576545
Name:FROIO, KELLY A (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:FROIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1007 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3963
Mailing Address - Country:US
Mailing Address - Phone:856-853-8004
Mailing Address - Fax:856-853-4654
Practice Address - Street 1:1007 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3963
Practice Address - Country:US
Practice Address - Phone:856-853-8004
Practice Address - Fax:856-853-4654
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00322100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093012Medicare UPIN