Provider Demographics
NPI:1932580404
Name:BORYS, KRISTIN IV (MS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BORYS
Suffix:IV
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:HAZLET TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-2958
Mailing Address - Country:US
Mailing Address - Phone:732-939-2790
Mailing Address - Fax:
Practice Address - Street 1:181 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:HAZLET TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07734-2958
Practice Address - Country:US
Practice Address - Phone:732-939-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00515800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701Medicaid
NJ7797403Medicaid