Individual
MS. MARISA H MCKIBBAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
300 CENTRAL AVE, EAST ORANGE, NJ 07018-2819
(973) 470-3000
(973) 470-3506
Mailing address
104 SOUTH AVE W, CRANFORD, NJ 07016-2652
(609) 320-1302
(973) 470-3506
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00167000
NJ
Other
Enumeration date
10/24/2006
Last updated
11/01/2011
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