Healthcare Provider Details

I. General information

NPI: 1518715192
Provider Name (Legal Business Name): KRYSTYN SANTIAGO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 JFK PKWY FL 1
SHORT HILLS NJ
07078-2713
US

IV. Provider business mailing address

51 JFK PKWY FL 1
SHORT HILLS NJ
07078-2713
US

V. Phone/Fax

Practice location:
  • Phone: 917-582-6622
  • Fax: 888-974-2142
Mailing address:
  • Phone: 917-582-6622
  • Fax: 888-974-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number729379
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405599
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: