Healthcare Provider Details

I. General information

NPI: 1871199695
Provider Name (Legal Business Name): KHRYSTYNA VULCHAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES ST STE 2B
EDISON NJ
08820-3947
US

IV. Provider business mailing address

362 WYOMING AVE
MILLBURN NJ
07041-2119
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01082900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01082900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: