Provider Demographics
NPI:1629552245
Name:KROSNICK, ANASTASIA A (APN)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:A
Last Name:KROSNICK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2309
Mailing Address - Country:US
Mailing Address - Phone:201-293-0976
Mailing Address - Fax:
Practice Address - Street 1:20 BANTA PL STE 208
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5606
Practice Address - Country:US
Practice Address - Phone:201-968-5168
Practice Address - Fax:201-968-5169
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00858000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health