Healthcare Provider Details

I. General information

NPI: 1114293115
Provider Name (Legal Business Name): KAITLIN JOHANNA REILLY-KIT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN JOHANNA REILLY M.D.

II. Dates (important events)

Enumeration Date: 03/24/2012
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ESSEX ST. SUITE 303
HACKENSACK NJ
07601
US

IV. Provider business mailing address

360 ESSEX ST. SUITE 303
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-8100
  • Fax:
Mailing address:
  • Phone: 551-996-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number273661
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA11047500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number273661
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number25MA11047500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: