Healthcare Provider Details

I. General information

NPI: 1457215980
Provider Name (Legal Business Name): KASANDRA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HELEN WAY
NETCONG NJ
07857-1518
US

IV. Provider business mailing address

10 HELEN WAY
NETCONG NJ
07857-1518
US

V. Phone/Fax

Practice location:
  • Phone: 973-420-5526
  • Fax:
Mailing address:
  • Phone: 973-420-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01450500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: