Provider Demographics
NPI:1780884346
Name:CISKO, KRISTINE M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:M
Last Name:CISKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 OVERLOOK RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3570
Mailing Address - Country:US
Mailing Address - Phone:908-522-9696
Mailing Address - Fax:908-522-3070
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:SUITE 307
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3570
Practice Address - Country:US
Practice Address - Phone:908-522-9696
Practice Address - Fax:908-522-3070
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00126100207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy