Provider Demographics
NPI:1487678462
Name:BORNHOEFT, KATHLEEN A (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:BORNHOEFT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3847
Mailing Address - Country:US
Mailing Address - Phone:609-815-7400
Mailing Address - Fax:609-815-7401
Practice Address - Street 1:1700 NOTTINGHAM WAY STE 108
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3501
Practice Address - Country:US
Practice Address - Phone:609-303-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00000400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0222585Medicaid
174795Medicare PIN