Basic Information
Provider Information | |||||||||
NPI: | 1144767708 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHIAVONE | ||||||||
FirstName: | KATHRYN | ||||||||
MiddleName: | JOY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STANCATO | ||||||||
OtherFirstName: | KATHRYN | ||||||||
OtherMiddleName: | JOY | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3600 ROUTE 66 | ||||||||
Address2: | FL 3 | ||||||||
City: | NEPTUNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 077532605 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7328070877 | ||||||||
FaxNumber: | 2017511680 | ||||||||
Practice Location | |||||||||
Address1: | 19 DAVIS AVE FL 5 | ||||||||
Address2: |   | ||||||||
City: | NEPTUNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 077534488 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7327763892 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/20/2017 | ||||||||
LastUpdateDate: | 08/31/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/31/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 26NJ00696300 | NJ | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.