Provider Demographics
NPI:1407909914
Name:GAETA, KATY M (CRNA)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:M
Last Name:GAETA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SCHANCK RD
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2964
Mailing Address - Country:US
Mailing Address - Phone:732-431-9544
Mailing Address - Fax:732-431-9313
Practice Address - Street 1:55 SCHANCK RD
Practice Address - Street 2:SUITE 8A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2963
Practice Address - Country:US
Practice Address - Phone:732-431-9544
Practice Address - Fax:732-431-9313
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NR06671400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered