Provider Demographics
NPI:1205131893
Name:KRESGE, CHRISTINA MICHELLE (MS)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:KRESGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BERGEN ST
Mailing Address - Street 2:SUITE 5400
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-3309
Mailing Address - Fax:973-972-3310
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:SUITE 5400
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-3309
Practice Address - Fax:973-972-3310
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MJ00001100170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS