Provider Demographics
NPI:1154178457
Name:MACIAG, ANGELA DOROTA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DOROTA
Last Name:MACIAG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:DOROTA
Other - Last Name:BAJOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6 WHITEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2422
Mailing Address - Country:US
Mailing Address - Phone:718-751-6280
Mailing Address - Fax:
Practice Address - Street 1:6 WHITEWOOD PL
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2422
Practice Address - Country:US
Practice Address - Phone:718-751-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00701400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant