Physician Assistant
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Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1508682568 · enumerated 2024-11-25 · record updated 2024-11-25. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Addresses and phones
- Practice location 401 HACKENSACK AVE STE 10TH, HACKENSACK, NJ, 07601-6411 (917) 561-3403 Google Maps Apple Maps OpenStreetMap
- Mailing address 14495 37TH AVE FL 2, FLUSHING, NY, 11354-5933 Google Maps Apple Maps OpenStreetMap
Specialties
- Physician Assistant 363A00000X · License 25MP00898100 NJ
- Physician Assistant 363A00000X · Primary · License 032974 NY
In this directory
Locations and evidence
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Practice location
HACKENSACK, NJ, 076016411
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.