Provider Demographics
NPI:1972887842
Name:KUPRYK, KRISTINA LEIGH (PA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LEIGH
Last Name:KUPRYK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5629
Mailing Address - Country:US
Mailing Address - Phone:862-226-1149
Mailing Address - Fax:
Practice Address - Street 1:245 DIAMOND BRIDGE AVENUE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506
Practice Address - Country:US
Practice Address - Phone:973-427-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00266800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical