Healthcare Provider Details

I. General information

NPI: 1871428649
Provider Name (Legal Business Name): ASHLEY TRAN KUSTAS PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NEW PROVIDENCE RD
MOUNTAINSIDE NJ
07092-2590
US

IV. Provider business mailing address

260 HICKORY LN
MOUNTAINSIDE NJ
07092-1814
US

V. Phone/Fax

Practice location:
  • Phone: 888-244-5373
  • Fax:
Mailing address:
  • Phone: 972-904-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: