Provider Demographics
NPI:1588247233
Name:SQUARE ONE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SQUARE ONE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPAR
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:856-938-8643
Mailing Address - Street 1:6 TAISLEY CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3207
Mailing Address - Country:US
Mailing Address - Phone:856-938-8642
Mailing Address - Fax:
Practice Address - Street 1:199 6TH AVE # B-2
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9749
Practice Address - Country:US
Practice Address - Phone:856-938-8642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty