Healthcare Provider Details

I. General information

NPI: 1477984953
Provider Name (Legal Business Name): KRISTINA VICTOR FAIR APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAINT GEORGES AVE SUITE 202
RAHWAY NJ
07065-2764
US

IV. Provider business mailing address

2903 VANTAGE CT
DENVILLE NJ
07834-3452
US

V. Phone/Fax

Practice location:
  • Phone: 732-499-0111
  • Fax:
Mailing address:
  • Phone: 973-343-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00494500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00494500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: