MEDICARE: KRISTOFER K STEINGALL PHYSICIAN ASSISTANT

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	363AM0700X	Medical Physician Assistant	25MP00315000	NJ
2	363A00000X	Physician Assistant	25MP00315000	NJ
3	363AS0400X	Surgical Physician Assistant	25MP00315000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154753051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTOFER K STEINGALL PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:	844-362-1735
Fax Number	:	973-290-7495

Provider Business Practice Location Address
First Line	:	333 MOUNT HOPE AVE STE 320
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-1657
Country	:	US
Telephone Number	:	973-625-5700
Fax Number	:	973-625-3381

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	12/29/2020

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Directions to “ KRISTOFER K STEINGALL PHYSICIAN ASSISTANT” Practice Location

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