Basic Information
Provider Information | |||||||||
NPI: | 1154520401 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SALVATI-BLOCK | ||||||||
FirstName: | KRISTINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SALVATI | ||||||||
OtherFirstName: | KRISTINA | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 227 LAUREL RD STE 300 | ||||||||
Address2: |   | ||||||||
City: | VOORHEES | ||||||||
State: | NJ | ||||||||
PostalCode: | 080438303 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8566696050 | ||||||||
FaxNumber: | 5652831178 | ||||||||
Practice Location | |||||||||
Address1: | 180 WHITE RD STE 209 | ||||||||
Address2: |   | ||||||||
City: | LITTLE SILVER | ||||||||
State: | NJ | ||||||||
PostalCode: | 077391166 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7328420673 | ||||||||
FaxNumber: | 7328427352 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2007 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 25MP00182300 | NJ | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
ID | Type | State | Issuer | Description | 25MP00182300 | 01 | NJ | NJ LICENSE | OTHER |