Individual
ASHLEY KOURGIALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-5430
Mailing address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00614100
NJ STATE MEDICAL LICENSE
NJ
Enumeration date
07/04/2018
Last updated
06/21/2022
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