Doctor Name: | IWONA PEDATELLA |
NPI Number: | 1043554512 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 25MP00290300 |
Business Practice Address: | 221 W Grand Ave Montvale, NJ - 076451729 |
Business Phone Number: | 2013070075 |
Business Fax Number: | |
Mailing Address: | 4000 Riverdale Rd, 402 RIVERDALE |
State: | NJ |
Postal Code: | 074571729 |
Phone Number: | 9738961344 |
Fax Number: | |
NPI Enumeration Date: | 11/21/2012 |
NPI Last Update Date: | 11/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 25MP00290300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |