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Individual

ANDRES VEGA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
916-922 MAIN AVE, PASSAIC, NJ 07055
(973) 773-0334
(973) 773-0336
Mailing address
916-922 MAIN AVE STE 1A, PASSAIC, NJ 07055-8544
(973) 773-0334
(973) 773-0336

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MP00336400
NJ
363A00000X
Physician Assistant
Primary
25MP00336400
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1639427495
GROUP NPI
NJ
Enumeration date
07/09/2014
Last updated
09/03/2021
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