Healthcare Provider Details

I. General information

NPI: 1487641676
Provider Name (Legal Business Name): CATHERINE A. CASSIDY PHD, APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MADISON AVE DREW UNIVERSITY HEALTH SERVICE
MADISON NJ
07940-1434
US

IV. Provider business mailing address

32 DURAND RD
MAPLEWOOD NJ
07040-1245
US

V. Phone/Fax

Practice location:
  • Phone: 973-408-3414
  • Fax:
Mailing address:
  • Phone: 973-762-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN02122100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: