Individual
DIMYANA ATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2500 ENGLISH CREEK AVE, EGG HARBOR TOWNSHIP, NJ 08234-5549
(609) 442-6803
Mailing address
200 ASHLAND AVE, EGG HARBOR TOWNSHIP, NJ 08234-5567
(609) 442-6803
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00534100
NJ
Other
Enumeration date
04/30/2019
Last updated
09/22/2019
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