Individual
MIYASARI RANOEWIDJOJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK UNIVERSITY MEDICAL CENTER, HACKENSACK, NJ 07601-1914
(201) 996-4614
Mailing address
45 GENOBLE RD, MONTVILLE, NJ 07045
(347) 223-8788
(973) 794-3555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00118300
NJ
Other
Enumeration date
05/14/2007
Last updated
12/13/2007
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