Provider Demographics
NPI:1588773790
Name:CASAS, THERESE P (PAC)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:P
Last Name:CASAS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:P
Other - Last Name:CASAS-BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:135 KINNELON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2333
Mailing Address - Country:US
Mailing Address - Phone:973-838-1771
Mailing Address - Fax:973-492-2858
Practice Address - Street 1:135 KINNELON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2333
Practice Address - Country:US
Practice Address - Phone:973-838-1771
Practice Address - Fax:973-492-2858
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003705363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00227500OtherSTATE LICENSE
GA003705OtherSTATE PA LICENSE NUMBER