Healthcare Provider Details

I. General information

NPI: 1588773790
Provider Name (Legal Business Name): THERESE P CASAS PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESE P CASAS-BROWN PA-C

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 KINNELON RD SUITE 103
KINNELON NJ
07405-2333
US

IV. Provider business mailing address

135 KINNELON RD SUITE 103
KINNELON NJ
07405-2333
US

V. Phone/Fax

Practice location:
  • Phone: 973-838-1771
  • Fax: 973-492-2858
Mailing address:
  • Phone: 973-838-1771
  • Fax: 973-492-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003705
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: