Provider Demographics
NPI:1881452456
Name:CARRAMUSA, KRISTA LACAP
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LACAP
Last Name:CARRAMUSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 HUBER PL
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2549
Mailing Address - Country:US
Mailing Address - Phone:201-450-5767
Mailing Address - Fax:
Practice Address - Street 1:271 HUBER PL
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2549
Practice Address - Country:US
Practice Address - Phone:201-450-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1030124001223G0001X
LA75731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice