Provider Demographics
NPI:1508034109
Name:SOBKIW-KURTZ, CASSANDRA LARA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LARA
Last Name:SOBKIW-KURTZ
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 1:104 LIGHTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6969
Mailing Address - Country:US
Mailing Address - Phone:856-952-7664
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE FL 1
Practice Address - Street 2:EMERGENCY TREATMENT ASSOCIATES
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-2908
Practice Address - Country:US
Practice Address - Phone:518-751-1016
Practice Address - Fax:518-751-1020
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1099363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBC736ZMedicare PIN