Provider Demographics
NPI:1710969241
Name:KRISZA, MARY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:KRISZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:27 PINCKNEY RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2106
Practice Address - Country:US
Practice Address - Phone:732-747-4600
Practice Address - Fax:732-219-1968
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0K4749OtherHEALTH NET
NJ2063204Medicaid
4274064OtherAETNA
NY44D262OtherEMPIRE BC/BS
NJP382709OtherOXFORD
NJ3175025OtherCIGNA
11207OtherAETNA HMO
NJ273674OtherUNITED HEALTHCARE
NY44D261OtherEMPIRE BC/BS
NY44D262OtherEMPIRE BC/BS
NJ273674OtherUNITED HEALTHCARE