Provider Demographics
NPI:1912479916
Name:HAID, COURTNEY M (PA - C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:HAID
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 1:345 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2383
Mailing Address - Country:US
Mailing Address - Phone:973-200-7370
Mailing Address - Fax:973-822-7905
Practice Address - Street 1:345 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2383
Practice Address - Country:US
Practice Address - Phone:973-200-7370
Practice Address - Fax:973-822-7905
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP791000363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty