MEDICARE: THERESA M KRISTON M.D.

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	208000000X	Pediatrics Physician	228889	MA

General Provider Information

NPI Number	:	1811922818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA M KRISTON M.D.

Provider Business Mailing Address
First Line	:	360 MAPLEWOOD AVE
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-3708
Country	:	US
Telephone Number	:	609-943-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 S CLINTON AVE
Second Line	:	2ND FLOOR
City	:	TRENTON
State	:	NJ
Zip	:	08609-1241
Country	:	US
Telephone Number	:	609-943-5810
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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