Provider Demographics
NPI:1497269625
Name:KRAYCINOVICH, PATRICIA A (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:KRAYCINOVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1452
Mailing Address - Country:US
Mailing Address - Phone:201-483-8044
Mailing Address - Fax:
Practice Address - Street 1:401 S VAN BRUNT ST STE 400
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-569-0555
Practice Address - Fax:201-569-0555
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00774100363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology