Provider Demographics
NPI:1912741166
Name:COLANGELO, KRISTY MARIE (RN)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:COLANGELO
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MADISON AVE RM 2000
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5416
Mailing Address - Country:US
Mailing Address - Phone:917-807-6984
Mailing Address - Fax:
Practice Address - Street 1:315 MADISON AVE RM 2000
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5416
Practice Address - Country:US
Practice Address - Phone:917-807-6984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22625900163WP0808X
NY406849363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health