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General NPI Number Information
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NPI Number | 1720511819
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Entity Type | Individual
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Provider Name | KRISTINE VICTORIA CORNEJO M.D.,M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 3322 ROUTE 22 STE 1204
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City | BRANCHBURG
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State | NJ
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Zip | 08876-4407
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Country | US
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Telephone | 908-378-7227
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Fax |
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Provider Business Mailing Address
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Address Line | 465 SOUTH ST STE 103
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6442
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Country | US
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Telephone | 973-971-8729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA10866600
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License Number State | NJ
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