Provider Demographics
NPI:1043963754
Name:KOTZ, CAITLIN MCGUIRE (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MCGUIRE
Last Name:KOTZ
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 1:1163 WASHINGTON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3587
Mailing Address - Country:US
Mailing Address - Phone:908-304-5442
Mailing Address - Fax:
Practice Address - Street 1:1163 WASHINGTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3587
Practice Address - Country:US
Practice Address - Phone:908-304-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ626659OtherEMT