=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952109878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID KRASNOV APN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2025
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 BROAD ST STE 207
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-974-6602
-----------------------------------------------------
Fax | 630-487-2411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 539 VAUGHN AVE APT A6
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08753-5880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-280-5725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ15291000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------