Healthcare Provider Details

I. General information

NPI: 1457715344
Provider Name (Legal Business Name): KRISTINA MARIE MASI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA MARIE CONIGLIARO

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E EVESHAM RD STE A1
VOORHEES NJ
08043-9590
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-3323
  • Fax:
Mailing address:
  • Phone: 610-482-4795
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA10830000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: