Provider Demographics
NPI:1659922870
Name:KRYSYNA, TAISA (MSN, APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TAISA
Middle Name:
Last Name:KRYSYNA
Suffix:
Gender:F
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9632
Mailing Address - Country:US
Mailing Address - Phone:973-865-8186
Mailing Address - Fax:
Practice Address - Street 1:379 MAIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1718
Practice Address - Country:US
Practice Address - Phone:973-779-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00965100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine