1619246014 NPI number — KASICA PROFESSIONAL ANESTHESIA AND PAIN SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619246014 NPI number — KASICA PROFESSIONAL ANESTHESIA AND PAIN SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KASICA PROFESSIONAL ANESTHESIA AND PAIN SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619246014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 W JIM LEEDS RD
Provider Second Line Business Mailing Address:
PARK CENTER, SUITE 501
Provider Business Mailing Address City Name:
GALLOWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08205-9411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-748-0505
Provider Business Mailing Address Fax Number:
609-748-0515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 W JIM LEEDS RD
Provider Second Line Business Practice Location Address:
PARK CENTER, SUITE 501
Provider Business Practice Location Address City Name:
GALLOWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08205-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-748-0505
Provider Business Practice Location Address Fax Number:
609-748-0515
Provider Enumeration Date:
12/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KASICA
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNDER
Authorized Official Telephone Number:
609-748-0505

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  25MB06313500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 25MB06313500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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