Individual
CORINA M IANCULOVICI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, AG-PCP
Contact information
Practice address
2640 HWY 70, BLDG.5, BUILDING #5, SUITE 102B, MANASQUAN, NJ 08736-9552
(732) 292-0100
(732) 292-0900
Mailing address
2640 HWY 70, BLDG.5, BUILDING #5, SUITE 102B, MANASQUAN, NJ 08736-9552
(347) 539-6369
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
26NJ00862000
NJ
363LP2300X
Primary Care Nurse Practitioner
Primary
26NJ00862000
NJ
Other
Enumeration date
04/11/2018
Last updated
10/03/2018
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