Provider Demographics
NPI:1407414337
Name:IGNOZZA, EMILY T (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:T
Last Name:IGNOZZA
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 1:140 N RTE 17 STE 200
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2829
Mailing Address - Country:US
Mailing Address - Phone:201-345-0100
Mailing Address - Fax:
Practice Address - Street 1:140 N RTE 17 STE 200
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2829
Practice Address - Country:US
Practice Address - Phone:201-345-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00528100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant