Healthcare Provider Details

I. General information

NPI: 1043779945
Provider Name (Legal Business Name): KRISTOPHER BIANCONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

267 COMMUNITY DR
SMITHTOWN NY
11787-3876
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-5000
  • Fax: 732-923-2272
Mailing address:
  • Phone: 802-376-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number322311-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA11478200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: