Basic Information
| Provider Information | |||||||||
| NPI: | 1881243665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KONECNY | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CAPITAL WAY | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085342520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093034000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 US HIGHWAY 22 STE 10B | ||||||||
| Address2: | |||||||||
| City: | GREEN BROOK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088121713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326249797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2019 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26NJ00922500 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.