Provider Demographics
NPI:1972996833
Name:MEJIA, DENISSE (PA-C)
Entity type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:MEJIA
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 1:1150 DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2210
Mailing Address - Country:US
Mailing Address - Phone:908-354-8900
Mailing Address - Fax:908-354-0007
Practice Address - Street 1:1150 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2210
Practice Address - Country:US
Practice Address - Phone:908-354-8900
Practice Address - Fax:908-354-0007
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00359900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant