Provider Demographics
NPI:1427480292
Name:MCCOOEY, KATE FREITAS (PA-C)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:FREITAS
Last Name:MCCOOEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 POCONO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3023
Mailing Address - Country:US
Mailing Address - Phone:973-316-1701
Mailing Address - Fax:
Practice Address - Street 1:23 POCONO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-3023
Practice Address - Country:US
Practice Address - Phone:973-316-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00312900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical