Provider Demographics
NPI:1912788696
Name:BISIG, KRYSTINA ANNE
Entity Type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:ANNE
Last Name:BISIG
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 1:211 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2407
Mailing Address - Country:US
Mailing Address - Phone:201-820-5997
Mailing Address - Fax:
Practice Address - Street 1:120 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2500
Practice Address - Country:US
Practice Address - Phone:201-528-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07017500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker