MEDICARE: THERESE P CASAS PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	003705	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25MP00227500	OTHER	NJ	STATE LICENSE
2	003705	OTHER	GA	STATE PA LICENSE NUMBER

General Provider Information

NPI Number	:	1588773790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE P CASAS PAC

Provider Business Mailing Address
First Line	:	135 KINNELON RD
Second Line	:	SUITE 103
City	:	KINNELON
State	:	NJ
Zip	:	07405-2333
Country	:	US
Telephone Number	:	973-838-1771
Fax Number	:	973-492-2858

Provider Business Practice Location Address
First Line	:	135 KINNELON RD
Second Line	:	SUITE 103
City	:	KINNELON
State	:	NJ
Zip	:	07405-2333
Country	:	US
Telephone Number	:	973-838-1771
Fax Number	:	973-492-2858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/29/2021

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Directions to “ THERESE P CASAS PAC” Practice Location

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