Basic Information
| Provider Information | |||||||||
| NPI: | 1831599976 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABANES | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 N VAN DIEN AVE | ||||||||
| Address2: | |||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074502726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014478000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 452 OLD HOOK RD | ||||||||
| Address2: | |||||||||
| City: | EMERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076301381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016663900 | ||||||||
| FaxNumber: | 2012610505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2014 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00497700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 26NJ00497700 | 01 | NJ | NJ APN LICENSE | OTHER |