| Doctor Name: | MR. ANGELO C MABASA |
| NPI Number: | 1033305578 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | 26NJ00133000 |
| Business Practice Address: | 196 Jewett Ave Jersey City, NJ - 073041804 |
| Business Phone Number: | 2015369000 |
| Business Fax Number: | 2015369047 |
| Mailing Address: | 196 Jewett Ave, JERSEY CITY |
| State: | NJ |
| Postal Code: | 073041804 |
| Phone Number: | 2015369000 |
| Fax Number: | 2015369047 |
| NPI Enumeration Date: | 09/19/2007 |
| NPI Last Update Date: | 09/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 26NJ00133000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |