Provider Demographics
NPI:1598419798
Name:HAN, DAVID D (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:HAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2352 LINWOOD AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3827
Mailing Address - Country:US
Mailing Address - Phone:201-921-1836
Mailing Address - Fax:201-328-9821
Practice Address - Street 1:2011 LEMOINE AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5715
Practice Address - Country:US
Practice Address - Phone:201-414-5565
Practice Address - Fax:201-328-9821
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2025-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY027897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant