MEDICARE: KRISTIN BORYS IV MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37PC00515800	NJ

General Provider Information

NPI Number	:	1932580404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN BORYS IV MS

Provider Business Mailing Address
First Line	:	181 LAUREL AVE
Second Line	:
City	:	HAZLET TOWNSHIP
State	:	NJ
Zip	:	07734-2958
Country	:	US
Telephone Number	:	732-939-2790
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 LAUREL AVE
Second Line	:
City	:	HAZLET TOWNSHIP
State	:	NJ
Zip	:	07734-2958
Country	:	US
Telephone Number	:	732-939-2790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	01/05/2023

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