Provider Demographics
NPI:1861568602
Name:MALLON, KRISTIN ANN (CNM)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ANN
Last Name:MALLON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3241
Mailing Address - Country:US
Mailing Address - Phone:718-612-5077
Mailing Address - Fax:
Practice Address - Street 1:358 BEECH ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1344
Practice Address - Country:US
Practice Address - Phone:201-487-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001235367A00000X
NJ25ME00050300176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife