Healthcare Provider Details

I. General information

NPI: 1497269625
Provider Name (Legal Business Name): PATRICIA A KRAYCINOVICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S VAN BRUNT ST STE 400
ENGLEWOOD NJ
07631-4604
US

IV. Provider business mailing address

210 COLONIAL RD
EMERSON NJ
07630-1452
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-0555
  • Fax: 201-569-0555
Mailing address:
  • Phone: 201-483-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00774100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00774100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: