Individual
KAITLYN PAIGE PROBASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7600 RIVER RD, NORTH BERGEN, NJ 07047-6217
(732) 644-7256
Mailing address
53 IVINS DR, NEW EGYPT, NJ 08533-2810
(732) 644-7256
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00453600
NJ
Other
Enumeration date
09/11/2017
Last updated
01/15/2018
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