Provider Demographics
NPI:1447094586
Name:SIMON, KRISTIANA LAUREANO (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:LAUREANO
Last Name:SIMON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POPLAR LN # 8B
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4502
Mailing Address - Country:US
Mailing Address - Phone:386-847-1193
Mailing Address - Fax:
Practice Address - Street 1:43 PRINCETON HIGHTSTOWN RD # 3
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1118
Practice Address - Country:US
Practice Address - Phone:609-955-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00874700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty