Healthcare Provider Details

I. General information

NPI: 1063222123
Provider Name (Legal Business Name): KITSA EVANGELIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E RTE 4 STE 490
PARAMUS NJ
07652-2622
US

IV. Provider business mailing address

10 TOBYHANNA TRL
HOPATCONG NJ
07843-1024
US

V. Phone/Fax

Practice location:
  • Phone: 201-389-1285
  • Fax: 201-445-4195
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15197400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: