Provider Demographics
NPI:1528835204
Name:ASSAF, AISHA JAWAD (PA-C)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:JAWAD
Last Name:ASSAF
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 1:211 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2955
Mailing Address - Country:US
Mailing Address - Phone:973-518-1348
Mailing Address - Fax:
Practice Address - Street 1:35 ACKERMAN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1501
Practice Address - Country:US
Practice Address - Phone:973-928-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant