Healthcare Provider Details

I. General information

NPI: 1831021997
Provider Name (Legal Business Name): KRISTINE ELISE BUSHONG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ
HACKENSACK NJ
07601-6202
US

IV. Provider business mailing address

1000 THOMAS RD UNIT 1210
ROCKAWAY NJ
07866-1229
US

V. Phone/Fax

Practice location:
  • Phone: 855-845-0555
  • Fax:
Mailing address:
  • Phone: 855-845-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00950400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: