Provider Demographics
NPI:1780084251
Name:KRYSTIN PRASAD LLC
Entity type:Organization
Organization Name:KRYSTIN PRASAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:848-210-7151
Mailing Address - Street 1:664 COMMONS WAY, BUILDING I
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:848-210-7151
Mailing Address - Fax:848-238-7424
Practice Address - Street 1:664 COMMONS WAY BLDG I
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6431
Practice Address - Country:US
Practice Address - Phone:848-210-7151
Practice Address - Fax:848-238-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00461700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty