MEDICARE: MISS CRISTIN ASHLEY FAMULARO A.P.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00201200	NJ
2	363LP0200X	Pediatric Nurse Practitioner	26NJ00201200	NJ

General Provider Information

NPI Number	:	1164655486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CRISTIN ASHLEY FAMULARO A.P.N

Provider Business Mailing Address
First Line	:	465 BLOOMFIELD AVE
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3548
Country	:	US
Telephone Number	:	973-587-8040
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 LACKAWANNA PL
Second Line	:	412
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2955
Country	:	US
Telephone Number	:	201-913-7146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	03/26/2026

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