Healthcare Provider Details

I. General information

NPI: 1174423966
Provider Name (Legal Business Name): KYRA BREITWEISER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

116 BLACK OAK RIDGE RD
WAYNE NJ
07470-7438
US

V. Phone/Fax

Practice location:
  • Phone: 201-478-0719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR23140800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: