Provider Demographics
NPI:1962054551
Name:AHEARN, VANESSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:AHEARN
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 1:5 FRANKLIN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3522
Mailing Address - Country:US
Mailing Address - Phone:973-759-1221
Mailing Address - Fax:
Practice Address - Street 1:5 FRANKLIN AVE STE 302
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3522
Practice Address - Country:US
Practice Address - Phone:973-759-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00531800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease