Provider Demographics
NPI:1285115204
Name:MIGNOGNA, EMILY C (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:MIGNOGNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 FORRESTAL RD S STE 205
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6666
Mailing Address - Country:US
Mailing Address - Phone:609-924-2230
Mailing Address - Fax:609-924-5006
Practice Address - Street 1:10 FORRESTAL RD S STE 205
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6666
Practice Address - Country:US
Practice Address - Phone:609-924-2230
Practice Address - Fax:609-924-5006
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060046363A00000X
NJ25MP00698900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant