Healthcare Provider Details

I. General information

NPI: 1659922870
Provider Name (Legal Business Name): TAISA KRYSYNA MSN, APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2019
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 MAIN AVE STE 3
WALLINGTON NJ
07057-1718
US

IV. Provider business mailing address

2 TAMARACK LN
PINE BROOK NJ
07058-9632
US

V. Phone/Fax

Practice location:
  • Phone: 973-779-2277
  • Fax:
Mailing address:
  • Phone: 973-865-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NJ00965100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: