Healthcare Provider Details

I. General information

NPI: 1194191049
Provider Name (Legal Business Name): AFFILIATED FIRST ASSISTANT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 PROSPECT AVE
DUMONT NJ
07628-1837
US

IV. Provider business mailing address

PO BOX 32
DUMONT NJ
07628-0032
US

V. Phone/Fax

Practice location:
  • Phone: 201-439-0230
  • Fax:
Mailing address:
  • Phone: 973-957-0548
  • Fax: 866-329-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1945030
License Number StateNJ

VIII. Authorized Official

Name: MS. ANDREA L BILLS
Title or Position: PROPRIETOR
Credential: RNFA
Phone: 973-957-0548