Active NPI
Kyle Jeremy Kreske, LAC
- Counselor
- Hawthorne, NJ
National Provider Identifier
1194415588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 37AC00671100
- Practice address
- 93 10TH Avenue
Hawthorne, NJ 07506 - Phone
- (201) 632-1474
- Fax
- (973) 907-2691
- NPI assigned
- May 10, 2023
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 37AC00671100 | NJ | Primary |
Addresses
Primary practice location
93 10TH Avenue
Hawthorne, NJ 07506
Mailing address
93 10TH Avenue
Hawthorne, NJ 07506
Phone (201) 632-1474
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37AC00671100 | NJ | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683676800000",
"number": "1194415588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "93 10TH AVENUE",
"city": "HAWTHORNE",
"state": "NJ",
"postal_code": "07506",
"telephone_number": "201-632-1474",
"fax_number": "973-907-2691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "93 10TH AVENUE",
"city": "HAWTHORNE",
"state": "NJ",
"postal_code": "07506",
"telephone_number": "201-632-1474",
"fax_number": "973-907-2691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRESKE",
"first_name": "KYLE",
"middle_name": "JEREMY",
"name_prefix": "Mr.",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-10",
"last_updated": "2023-05-10",
"certification_date": "2023-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor",
"state": "NJ",
"license": "37AC00671100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hawthorne, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.