Healthcare Provider Details

I. General information

NPI: 1174653935
Provider Name (Legal Business Name): KATHLEEN E HASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N NEW RD
PLEASANTVILLE NJ
08232-2170
US

IV. Provider business mailing address

1036 BLUEBIRD CIR
MAYS LANDING NJ
08330-5614
US

V. Phone/Fax

Practice location:
  • Phone: 609-646-4064
  • Fax:
Mailing address:
  • Phone: 609-241-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License Number111290
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: