Provider Demographics
NPI:1720511819
Name:CORNEJO, KRISTINE VICTORIA (MD,MPH)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:VICTORIA
Last Name:CORNEJO
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
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Mailing Address - Street 1:465 SOUTH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6442
Mailing Address - Country:US
Mailing Address - Phone:973-971-8729
Mailing Address - Fax:
Practice Address - Street 1:3322 ROUTE 22 STE 1204
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-4407
Practice Address - Country:US
Practice Address - Phone:908-378-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10866600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty