=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437957693
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAITLYN CESTARO APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2025
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 MANHATTAN DR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08016-4119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-386-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 PASSAIC AVE
-----------------------------------------------------
City | ROSELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07068-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-462-7219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ15286700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------