Individual
REBECCA TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 CENTRAL AVE, NEWARK, NJ 07102-1909
(973) 877-5500
Mailing address
111 CENTRAL AVE, NEWARK, NJ 07102-1909
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00310800
NJ
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0469718
—
NJ
Enumeration date
06/28/2013
Last updated
05/01/2023
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