Provider Demographics
NPI:1699976464
Name:O'REILLY, KATHLEEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:O'REILLY
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 1:283 KING GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5134
Mailing Address - Country:US
Mailing Address - Phone:908-563-5400
Mailing Address - Fax:908-563-5405
Practice Address - Street 1:283 KING GEORGE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5134
Practice Address - Country:US
Practice Address - Phone:908-563-5400
Practice Address - Fax:908-563-5405
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant