Individual
MR. JOHN EDWARD AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
65 CONCORD AVE, GLEN ROCK, NJ 07452-1602
(201) 612-0907
Mailing address
65 CONCORD AVE, GLEN ROCK, NJ 07452-1602
(201) 612-0907
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MP00475
NJ
Other
Enumeration date
10/21/2006
Last updated
07/08/2007
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