Provider Demographics
NPI:1386392066
Name:KRISTY A NANARTOWICZ PSY D, LLC
Entity type:Organization
Organization Name:KRISTY A NANARTOWICZ PSY D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NANARTOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:732-664-2298
Mailing Address - Street 1:1166 BUCCANEER LN
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-4844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1166 BUCCANEER LN
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-4844
Practice Address - Country:US
Practice Address - Phone:732-664-2298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35SI00646500OtherSTATE LICENSE