Provider Demographics
NPI:1417013905
Name:KASICA, PATRICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:KASICA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:STOCKTON MEDICAL BUILDING, SUITE 2700
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-748-0505
Mailing Address - Fax:609-748-0515
Practice Address - Street 1:76 W JIM LEEDS RD
Practice Address - Street 2:PARK CENTER, SUITE 501
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9411
Practice Address - Country:US
Practice Address - Phone:609-748-0505
Practice Address - Fax:609-748-0515
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06313500207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ692192YGABMedicare UPIN
NJ692192Medicare PIN