Provider Demographics
NPI:1396151577
Name:PHILIPS, KAITLYN (DO)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVENUE
Mailing Address - Street 2:WFAN - 3RD FL
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:551-996-5300
Mailing Address - Fax:551-996-3051
Practice Address - Street 1:30 PROSPECT AVENUE
Practice Address - Street 2:WFAN - 3RD FL
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:551-996-5300
Practice Address - Fax:551-996-3051
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09661100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics