Healthcare Provider Details

I. General information

NPI: 1154243632
Provider Name (Legal Business Name): KATRINA MASIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE
MOUNT HOLLY NJ
08060-2038
US

IV. Provider business mailing address

8203 REGAT CT
BORDENTOWN NJ
08505
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6000
  • Fax:
Mailing address:
  • Phone: 732-963-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR22828900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: