Provider Demographics
NPI:1316378656
Name:KATHLEEN CRESCENZI APN,C,LLC
Entity Type:Organization
Organization Name:KATHLEEN CRESCENZI APN,C,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESCENZI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:908-654-1032
Mailing Address - Street 1:209 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1940
Mailing Address - Country:US
Mailing Address - Phone:908-654-1032
Mailing Address - Fax:
Practice Address - Street 1:513 W MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1710
Practice Address - Country:US
Practice Address - Phone:908-654-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty