Provider Demographics
NPI:1588441802
Name:BANAS, KRISTINE ANN (APN)
Entity type:Individual
Prefix:
First Name:KRISTINE ANN
Middle Name:
Last Name:BANAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 E CHESTNUT AVE STE 8A
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5053
Mailing Address - Country:US
Mailing Address - Phone:856-691-1230
Mailing Address - Fax:844-728-7976
Practice Address - Street 1:1138 E CHESTNUT AVE STE 8A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5053
Practice Address - Country:US
Practice Address - Phone:856-691-1230
Practice Address - Fax:844-728-1976
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14898800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine