Healthcare Provider Details

I. General information

NPI: 1255063541
Provider Name (Legal Business Name): MISS KRISTYNA ELENA ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 HOES LN W
PISCATAWAY NJ
08854-8021
US

IV. Provider business mailing address

111 BROOKWOOD RD
CLIFTON NJ
07012-1340
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06113400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: