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1326602004 NPI number — KRISTINA CORVESE BYSTRAK DPM

NPI Number: 1326602004
Health Care Provider/Practitioner: KRISTINA CORVESE BYSTRAK DPM

Information about “1326602004” NPI (KRISTINA CORVESE BYSTRAK DPM) exists in 1326602004 in HTML format HTML  |  1326602004 in plain Text format TXT  |  1326602004 in PDF (Portable Document Format) PDF  |  1326602004 in an XML format XML  formats.

NPI Number : 1326602004 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326602004",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BYSTRAK",
    "FirstName": "KRISTINA",
    "MiddleName": "CORVESE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "DPM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8 MARGARET TER",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOLCOTT",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06716-2546",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "203-558-0674",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5311 LIMESTONE RD STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILMINGTON",
    "PracticeLocationAddressStateName": "DE",
    "PracticeLocationAddressPostalCode": "19808-1258",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "302-239-1022",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/28/2019",
    "LastUpdateDate": "02/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": "E1-0010285",
          "LicenseNumberStateCode": "DE",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "1132",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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