Individual
CONSTANCE PETINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1828 W LAKE AVE, NEPTUNE, NJ 07753-4663
(732) 869-5754
Mailing address
1828 WEST LAKE AVENUE, NEPTUNE, NJ 07753-4663
(732) 869-5754
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00097600
NJ
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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