Healthcare Provider Details

I. General information

NPI: 1790677904
Provider Name (Legal Business Name): KAYLA ANZALONE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 JACK MARTIN BLVD
BRICK NJ
08724-7732
US

IV. Provider business mailing address

7 E ACRES DR
HAMILTON NJ
08620-9734
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-2200
  • Fax:
Mailing address:
  • Phone: 201-458-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ15601100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: