Provider Demographics
NPI:1992312656
Name:BEGLIOMINI, ALEXIS (PA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BEGLIOMINI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 LUCILLE CT
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18038-9797
Mailing Address - Country:US
Mailing Address - Phone:610-462-9469
Mailing Address - Fax:973-921-2800
Practice Address - Street 1:193 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1211
Practice Address - Country:US
Practice Address - Phone:908-481-1270
Practice Address - Fax:973-921-2800
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00579700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00579700OtherLICENSE #