Provider Demographics
NPI:1720511819
Name:CORNEJO, KRISTINE VICTORIA (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:VICTORIA
Last Name:CORNEJO
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5678 BERKSHIRE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9348
Mailing Address - Country:US
Mailing Address - Phone:609-709-0415
Mailing Address - Fax:
Practice Address - Street 1:5678 BERKSHIRE VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9348
Practice Address - Country:US
Practice Address - Phone:973-697-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10866600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty