Individual
KRISTYN PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
101 2ND ST, LAKEWOOD, NJ 08701-3324
(732) 363-6655
Mailing address
101 2ND ST, LAKEWOOD, NJ 08701-3324
(732) 363-6655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA08422600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA08422600
STATE LICENSE
NJ
Enumeration date
06/27/2008
Last updated
03/20/2013
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