Healthcare Provider Details

I. General information

NPI: 1619095122
Provider Name (Legal Business Name): KRISTINE KUBIK GEWANT OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PLEASANT HILL RD
CHESTER NJ
07930-2141
US

IV. Provider business mailing address

39 CLOVER HILL DR
FLANDERS NJ
07836-9558
US

V. Phone/Fax

Practice location:
  • Phone: 973-584-7500
  • Fax:
Mailing address:
  • Phone: 973-668-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00252500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: