Healthcare Provider Details

I. General information

NPI: 1881550150
Provider Name (Legal Business Name): ABDUL HAYYI ABUBAKAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 FRIES MILL RD
BLACKWOOD NJ
08012-2086
US

IV. Provider business mailing address

3500 N BROAD ST
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 856-516-4566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00971100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: