Healthcare Provider Details

I. General information

NPI: 1376408419
Provider Name (Legal Business Name): ANNA KRAVTSOV D.O. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 PROSPECT AVE APT 4E
HACKENSACK NJ
07601-1922
US

IV. Provider business mailing address

77 PROSPECT AVE APT 4E
HACKENSACK NJ
07601-1922
US

V. Phone/Fax

Practice location:
  • Phone: 201-341-1605
  • Fax:
Mailing address:
  • Phone: 201-341-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNA KRAVTSOV
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 201-341-1605