Provider Demographics
NPI:1407963549
Name:SAWICKI, KRISTY ANN (PA-C, ATC)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:ANN
Last Name:SAWICKI
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ESSEX ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8550
Mailing Address - Country:US
Mailing Address - Phone:551-996-8867
Mailing Address - Fax:551-996-8873
Practice Address - Street 1:360 ESSEX ST
Practice Address - Street 2:SUITE 303
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8550
Practice Address - Country:US
Practice Address - Phone:551-996-8867
Practice Address - Fax:551-996-8873
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126-0009952255A2300X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer