Active NPI
Kristofferson M Pineda, ANP - BC
- Adult Health Nurse Practitioner
- Englewood, NJ
National Provider Identifier
1023363561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 26NJ00459700
- Practice address
- 350 Engle St
Englewood, NJ 07631-1898 - Phone
- (201) 894-3908
- NPI assigned
- Jul 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 26NJ00459700 | NJ | Primary |
Addresses
Primary practice location
350 Engle St
Englewood, NJ 07631-1898
Mailing address
11 Revere PL
Tappan, NY 10983-1016
Phone (845) 461-5233
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240610002724 | NJ | Order and Referring Only - Cardiovascular Disease (Cardiology) | 8820530520 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305877 | NY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722556800000",
"number": "1023363561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 REVERE PL",
"city": "TAPPAN",
"state": "NY",
"postal_code": "109831016",
"telephone_number": "845-461-5233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 ENGLE ST",
"city": "ENGLEWOOD",
"state": "NJ",
"postal_code": "076311898",
"telephone_number": "201-894-3908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINEDA",
"first_name": "KRISTOFFERSON",
"middle_name": "M",
"credential": "ANP - BC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-20",
"last_updated": "2024-08-02",
"certification_date": "2024-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "NJ",
"license": "26NJ00459700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Englewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.