Healthcare Provider Details

I. General information

NPI: 1013923143
Provider Name (Legal Business Name): CORTNEY SEITZ PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 ROUTE 33 K HOVNANIAN CHILDREN'S HOSPITAL
NEPTUNE NJ
07753
US

IV. Provider business mailing address

2101 ROUTE 34
WALL TOWNSHIP NJ
07719-9104
US

V. Phone/Fax

Practice location:
  • Phone: 732-413-3626
  • Fax: 732-776-2344
Mailing address:
  • Phone: 732-974-0003
  • Fax: 732-970-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00174300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00174300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: