Provider Demographics
NPI:1306035407
Name:KRISTINE GEDROIC M.D.LLC
Entity type:Organization
Organization Name:KRISTINE GEDROIC M.D.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEDROIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-993-4445
Mailing Address - Street 1:22 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-8803
Mailing Address - Country:US
Mailing Address - Phone:973-993-4445
Mailing Address - Fax:973-993-4942
Practice Address - Street 1:22 ELM ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8803
Practice Address - Country:US
Practice Address - Phone:973-993-4445
Practice Address - Fax:973-993-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08152100261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center