Provider Demographics
NPI:1316904469
Name:CRESCENZI, KATHLEEN (APRN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:CRESCENZI
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1940
Mailing Address - Country:US
Mailing Address - Phone:908-654-1032
Mailing Address - Fax:
Practice Address - Street 1:212 SHORT HILLS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1040
Practice Address - Country:US
Practice Address - Phone:973-467-3267
Practice Address - Fax:973-564-9070
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC07311500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8941009Medicaid
NJ065298Medicare ID - Type Unspecified
NJP75378Medicare UPIN