Healthcare Provider Details

I. General information

NPI: 1174370878
Provider Name (Legal Business Name): KRISTIN SHARMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CUPSAW DR
RINGWOOD NJ
07456-2306
US

IV. Provider business mailing address

PO BOX 22
RINGWOOD NJ
07456-0022
US

V. Phone/Fax

Practice location:
  • Phone: 201-694-1075
  • Fax:
Mailing address:
  • Phone: 201-694-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN SHARMA
Title or Position: MANAGER
Credential:
Phone: 201-694-1075